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Dheerendra P, Grent-'t-Jong T, Gajwani R, Gross J, Gumley AI, Krishnadas R, Lawrie SM, Schwannauer M, Schultze-Lutter F, Uhlhaas PJ. Intact Mismatch Negativity Responses in Clinical High Risk for Psychosis and First-Episode Psychosis: Evidence From Source-Reconstructed Event-Related Fields and Time-Frequency Data. Biol Psychiatry Cogn Neurosci Neuroimaging 2024; 9:121-131. [PMID: 37778724 DOI: 10.1016/j.bpsc.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/26/2023] [Accepted: 09/21/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND This study examined whether mismatch negativity (MMN) responses are impaired in participants at clinical high risk for psychosis (CHR-P) and patients with first-episode psychosis (FEP) and whether MMN deficits predict clinical outcomes in CHR-Ps. METHODS Magnetoencephalography data were collected during a duration-deviant MMN paradigm for a group of 116 CHR-P participants, 33 FEP patients (15 antipsychotic-naïve), clinical high risk negative group (n = 38) with substance abuse and affective disorder, and 49 healthy control participants. Analysis of group differences of source-reconstructed event-related fields as well as time-frequency and intertrial phase coherence focused on the bilateral Heschl's gyri and bilateral superior temporal gyri. RESULTS Significant magnetic MMN responses were found across participants in the bilateral Heschl's gyri and bilateral superior temporal gyri. However, MMN amplitude as well as time-frequency and intertrial phase coherence responses were intact in CHR-P participants and FEP patients compared with healthy control participants. Furthermore, MMN deficits were not related to persistent attenuated psychotic symptoms or transitions to psychosis in CHR-P participants. CONCLUSIONS Our data suggest that magnetic MMN responses in magnetoencephalography data are not impaired in early-stage psychosis and may not predict clinical outcomes in CHR-P participants.
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Affiliation(s)
- Pradeep Dheerendra
- School of Psychology and Neuroscience, University of Glasgow, Glasgow, United Kingdom
| | - Tineke Grent-'t-Jong
- School of Psychology and Neuroscience, University of Glasgow, Glasgow, United Kingdom; Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Ruchika Gajwani
- Mental Health and Wellbeing, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Joachim Gross
- Institute for Biomagnetism and Biosignalanalysis, University of Münster, Muenster, Germany
| | - Andrew I Gumley
- Mental Health and Wellbeing, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Rajeev Krishnadas
- School of Psychology and Neuroscience, University of Glasgow, Glasgow, United Kingdom
| | - Stephen M Lawrie
- Department of Psychiatry, University of Edinburgh, Edinburgh, United Kingdom
| | - Matthias Schwannauer
- Department of Clinical Psychology, University of Edinburgh, Edinburgh, United Kingdom
| | - Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany; Department of Psychology, Faculty of Psychology, Airlangga University, Surabaya, Indonesia; University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Peter J Uhlhaas
- School of Psychology and Neuroscience, University of Glasgow, Glasgow, United Kingdom; Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany.
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Hua L, Adams RA, Grent-'t-Jong T, Gajwani R, Gross J, Gumley AI, Krishnadas R, Lawrie SM, Schultze-Lutter F, Schwannauer M, Uhlhaas PJ. Thalamo-cortical circuits during sensory attenuation in emerging psychosis: a combined magnetoencephalography and dynamic causal modelling study. Schizophrenia (Heidelb) 2023; 9:25. [PMID: 37117187 PMCID: PMC10147678 DOI: 10.1038/s41537-023-00341-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 02/28/2023] [Indexed: 04/30/2023]
Abstract
Evidence suggests that schizophrenia (ScZ) involves impairments in sensory attenuation. It is currently unclear, however, whether such deficits are present during early-stage psychosis as well as the underlying network and the potential as a biomarker. To address these questions, Magnetoencephalography (MEG) was used in combination with computational modeling to examine M100 responses that involved a "passive" condition during which tones were binaurally presented, while in an "active" condition participants were asked to generate a tone via a button press. MEG data were obtained from 109 clinical high-risk for psychosis (CHR-P) participants, 23 people with a first-episode psychosis (FEP), and 48 healthy controls (HC). M100 responses at sensor and source level in the left and right thalamus (THA), Heschl's gyrus (HES), superior temporal gyrus (STG) and right inferior parietal cortex (IPL) were examined and dynamic causal modeling (DCM) was performed. Furthermore, the relationship between sensory attenuation and persistence of attenuated psychotic symptoms (APS) and transition to psychosis was investigated in CHR-P participants. Sensory attenuation was impaired in left HES, left STG and left THA in FEP patients, while in the CHR-P group deficits were observed only in right HES. DCM results revealed that CHR-P participants showed reduced top-down modulation from the right IPL to the right HES. Importantly, deficits in sensory attenuation did not predict clinical outcomes in the CHR-P group. Our results show that early-stage psychosis involves impaired sensory attenuation in auditory and thalamic regions but may not predict clinical outcomes in CHR-P participants.
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Affiliation(s)
- Lingling Hua
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, UK
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, 264 Guangzhou Road, Nanjing, 210029, China
| | - Rick A Adams
- Centre for Medical Image Computing and AI, University College London, 90 High Holborn, London, WC1V 6LJ, UK
- Max Planck-UCL Centre for Computational Psychiatry and Ageing Research, 10-12 Russell Square, London, WC1B 5EH, UK
| | - Tineke Grent-'t-Jong
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, UK
- Department of Child and Adolescent Psychiatry, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany
| | - Ruchika Gajwani
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Joachim Gross
- Institute for Biomagnetism and Biosignalanalysis, University of Muenster, Muenster, Germany
| | - Andrew I Gumley
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Rajeev Krishnadas
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, UK
| | - Stephen M Lawrie
- Department of Psychiatry, University of Edinburgh, Edinburgh, UK
| | - Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
- Department of Psychology, Faculty of Psychology, Airlangga University, Surabaya, Indonesia
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | | | - Peter J Uhlhaas
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, UK.
- Department of Child and Adolescent Psychiatry, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany.
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Bianciardi B, Gajwani R, Gross J, Gumley AI, Lawrie SM, Moelling M, Schwannauer M, Schultze‐Lutter F, Fracasso A, Uhlhaas PJ. Investigating temporal and prosodic markers in clinical high-risk for psychosis participants using automated acoustic analysis. Early Interv Psychiatry 2023; 17:327-330. [PMID: 36205386 PMCID: PMC10946925 DOI: 10.1111/eip.13357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 05/14/2022] [Accepted: 09/18/2022] [Indexed: 11/27/2022]
Abstract
AIM Language disturbances are a candidate biomarker for the early detection of psychosis. Temporal and prosodic abnormalities have been observed in schizophrenia patients, while there is conflicting evidence whether such deficits are present in participants meeting clinical high-risk for psychosis (CHR-P) criteria. METHODS Clinical interviews from CHR-P participants (n = 50) were examined for temporal and prosodic metrics and compared against a group of healthy controls (n = 17) and participants with affective disorders and substance abuse (n = 23). RESULTS There were no deficits in acoustic variables in the CHR-P group, while participants with affective disorders/substance abuse were characterized by slower speech rate, longer pauses and higher unvoiced frames percentage. CONCLUSION Our finding suggests that temporal and prosodic aspects of speech are not impaired in early-stage psychosis. Further studies are required to clarify whether such abnormalities are present in sub-groups of CHR-P participants with elevated psychosis-risk.
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Affiliation(s)
- Bianca Bianciardi
- Institute of Neuroscience and PsychologyUniversity of GlasgowGlasgowUK
| | - Ruchika Gajwani
- School of Health and WellbeingUniversity of GlasgowGlasgowUK
| | - Joachim Gross
- Institute for Biomagnetism and BiosignalanalysisUniversity of MuensterMuensterGermany
| | | | | | - Melina Moelling
- Institute of Neuroscience and PsychologyUniversity of GlasgowGlasgowUK
| | | | - Frauke Schultze‐Lutter
- Department of Psychiatry and Psychotherapy, Medical FacultyHeinrich Heine UniversityDüsseldorfGermany
- Department of Psychology, Faculty of PsychologyAirlangga UniversitySurabayaIndonesia
- University Hospital of Child and Adolescent Psychiatry and PsychotherapyUniversity of BernBernSwitzerland
| | - Alessio Fracasso
- Institute of Neuroscience and PsychologyUniversity of GlasgowGlasgowUK
| | - Peter J. Uhlhaas
- Institute of Neuroscience and PsychologyUniversity of GlasgowGlasgowUK
- Department of Child and Adolescent PsychiatryCharité UniversitätsmedizinBerlinGermany
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4
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Gumley AI, Bradstreet S, Ainsworth J, Allan S, Alvarez-Jimenez M, Birchwood M, Briggs A, Bucci S, Cotton S, Engel L, French P, Lederman R, Lewis S, Machin M, MacLennan G, McLeod H, McMeekin N, Mihalopoulos C, Morton E, Norrie J, Reilly F, Schwannauer M, Singh SP, Sundram S, Thompson A, Williams C, Yung A, Aucott L, Farhall J, Gleeson J. Digital smartphone intervention to recognise and manage early warning signs in schizophrenia to prevent relapse: the EMPOWER feasibility cluster RCT. Health Technol Assess 2022; 26:1-174. [PMID: 35639493 DOI: 10.3310/hlze0479] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Relapse is a major determinant of outcome for people with a diagnosis of schizophrenia. Early warning signs frequently precede relapse. A recent Cochrane Review found low-quality evidence to suggest a positive effect of early warning signs interventions on hospitalisation and relapse. OBJECTIVE How feasible is a study to investigate the clinical effectiveness and cost-effectiveness of a digital intervention to recognise and promptly manage early warning signs of relapse in schizophrenia with the aim of preventing relapse? DESIGN A multicentre, two-arm, parallel-group cluster randomised controlled trial involving eight community mental health services, with 12-month follow-up. SETTINGS Glasgow, UK, and Melbourne, Australia. PARTICIPANTS Service users were aged > 16 years and had a schizophrenia spectrum disorder with evidence of a relapse within the previous 2 years. Carers were eligible for inclusion if they were nominated by an eligible service user. INTERVENTIONS The Early signs Monitoring to Prevent relapse in psychosis and prOmote Wellbeing, Engagement, and Recovery (EMPOWER) intervention was designed to enable participants to monitor changes in their well-being daily using a mobile phone, blended with peer support. Clinical triage of changes in well-being that were suggestive of early signs of relapse was enabled through an algorithm that triggered a check-in prompt that informed a relapse prevention pathway, if warranted. MAIN OUTCOME MEASURES The main outcomes were feasibility of the trial and feasibility, acceptability and usability of the intervention, as well as safety and performance. Candidate co-primary outcomes were relapse and fear of relapse. RESULTS We recruited 86 service users, of whom 73 were randomised (42 to EMPOWER and 31 to treatment as usual). Primary outcome data were collected for 84% of participants at 12 months. Feasibility data for people using the smartphone application (app) suggested that the app was easy to use and had a positive impact on motivations and intentions in relation to mental health. Actual app usage was high, with 91% of users who completed the baseline period meeting our a priori criterion of acceptable engagement (> 33%). The median time to discontinuation of > 33% app usage was 32 weeks (95% confidence interval 14 weeks to ∞). There were 8 out of 33 (24%) relapses in the EMPOWER arm and 13 out of 28 (46%) in the treatment-as-usual arm. Fewer participants in the EMPOWER arm had a relapse (relative risk 0.50, 95% confidence interval 0.26 to 0.98), and time to first relapse (hazard ratio 0.32, 95% confidence interval 0.14 to 0.74) was longer in the EMPOWER arm than in the treatment-as-usual group. At 12 months, EMPOWER participants were less fearful of having a relapse than those in the treatment-as-usual arm (mean difference -4.29, 95% confidence interval -7.29 to -1.28). EMPOWER was more costly and more effective, resulting in an incremental cost-effectiveness ratio of £3041. This incremental cost-effectiveness ratio would be considered cost-effective when using the National Institute for Health and Care Excellence threshold of £20,000 per quality-adjusted life-year gained. LIMITATIONS This was a feasibility study and the outcomes detected cannot be taken as evidence of efficacy or effectiveness. CONCLUSIONS A trial of digital technology to monitor early warning signs that blended with peer support and clinical triage to detect and prevent relapse is feasible. FUTURE WORK A main trial with a sample size of 500 (assuming 90% power and 20% dropout) would detect a clinically meaningful reduction in relapse (relative risk 0.7) and improvement in other variables (effect sizes 0.3-0.4). TRIAL REGISTRATION This trial is registered as ISRCTN99559262. FUNDING This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 27. See the NIHR Journals Library website for further project information. Funding in Australia was provided by the National Health and Medical Research Council (APP1095879).
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Affiliation(s)
- Andrew I Gumley
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Simon Bradstreet
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - John Ainsworth
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Stephanie Allan
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Mario Alvarez-Jimenez
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Maximillian Birchwood
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Andrew Briggs
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Sue Cotton
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia
| | - Lidia Engel
- School of Health and Social Development, Deakin University, Melbourne, VIC, Australia
| | - Paul French
- Department of Nursing, Manchester Metropolitan University, Manchester, UK
| | - Reeva Lederman
- School of Computing and Information Systems, Melbourne School of Engineering, University of Melbourne, Melbourne, VIC, Australia
| | - Shôn Lewis
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Matthew Machin
- Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Graeme MacLennan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Hamish McLeod
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Nicola McMeekin
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Cathy Mihalopoulos
- School of Health and Social Development, Deakin University, Melbourne, VIC, Australia
| | - Emma Morton
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - John Norrie
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | | | | | - Swaran P Singh
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Suresh Sundram
- Department of Psychiatry, Monash University, Melbourne, VIC, Australia
| | - Andrew Thompson
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia.,Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Chris Williams
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Alison Yung
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Lorna Aucott
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - John Farhall
- Department of Psychology and Counselling, La Trobe University, Melbourne, VIC, Australia.,NorthWestern Mental Health, Melbourne, VIC, Australia
| | - John Gleeson
- Healthy Brain and Mind Research Centre, Australian Catholic University, Melbourne, VIC, Australia
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5
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Gumley AI, Bradstreet S, Ainsworth J, Allan S, Alvarez-Jimenez M, Aucott L, Birchwood M, Briggs A, Bucci S, Cotton SM, Engel L, French P, Lederman R, Lewis S, Machin M, MacLennan G, McLeod H, McMeekin N, Mihalopoulos C, Morton E, Norrie J, Schwannauer M, Singh SP, Sundram S, Thompson A, Williams C, Yung AR, Farhall J, Gleeson J. The EMPOWER blended digital intervention for relapse prevention in schizophrenia: a feasibility cluster randomised controlled trial in Scotland and Australia. Lancet Psychiatry 2022; 9:477-486. [PMID: 35569503 DOI: 10.1016/s2215-0366(22)00103-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Early warning signs monitoring by service users with schizophrenia has shown promise in preventing relapse but the quality of evidence is low. We aimed to establish the feasibility of undertaking a definitive randomised controlled trial to determine the effectiveness of a blended digital intervention for relapse prevention in schizophrenia. METHODS This multicentre, feasibility, cluster randomised controlled trial aimed to compare Early signs Monitoring to Prevent relapse in psychosis and prOmote Well-being, Engagement, and Recovery (EMPOWER) with treatment as usual in community mental health services (CMHS) in Glasgow and Melbourne. CMHS were the unit of randomisation, selected on the basis of those that probably had five or more care coordinators willing to participate. Participants were eligible if they were older than 16 years, had a schizophrenia or related diagnosis confirmed via case records, were able to provide informed consent, had contact with CMHS, and had had a relapse within the previous 2 years. Participants were randomised within stratified clusters to EMPOWER or to continue their usual approach to care. EMPOWER blended a smartphone for active monitoring of early warning signs with peer support to promote self-management and clinical triage to promote access to relapse prevention. Main outcomes were feasibility, acceptability, usability, and safety, which was assessed through face-to-face interviews. App usage was assessed via the smartphone and self-report. Primary end point was 12 months. Participants, research assistants and other team members involved in delivering the intervention were not masked to treatment conditions. Assessment of relapse was done by an independent adjudication panel masked to randomisation group. The study is registered at ISRCTN (99559262). FINDINGS We identified and randomised eight CMHS (six in Glasgow and two in Melbourne) comprising 47 care coordinators. We recruited 86 service users between Jan 19 and Aug 8, 2018; 73 were randomised (42 [58%] to EMPOWER and 31 [42%] to treatment as usual). There were 37 (51%) men and 36 (49%) women. At 12 months, main outcomes were collected for 32 (76%) of service users in the EMPOWER group and 30 (97%) of service users in the treatment as usual group. Of those randomised to EMPOWER, 30 (71%) met our a priori criterion of more than 33% adherence to daily monitoring that assumed feasibility. Median time to discontinuation of these participants was 31·5 weeks (SD 14·5). There were 29 adverse events in the EMPOWER group and 25 adverse events in the treatment as usual group. There were 13 app-related adverse events, affecting 11 people, one of which was serious. Fear of relapse was lower in the EMPOWER group than in the treatment as usual group at 12 months (mean difference -7·53 (95% CI -14·45 to 0·60; Cohen's d -0·53). INTERPRETATION A trial of digital technology to monitor early warning signs blended with peer support and clinical triage to detect and prevent relapse appears to be feasible, safe, and acceptable. A further main trial is merited. FUNDING UK National Institute for Health Research Health Technology Assessment programme and the Australian National Health and Medical Research Council.
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Affiliation(s)
- Andrew I Gumley
- Glasgow Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
| | - Simon Bradstreet
- Glasgow Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - John Ainsworth
- Division of Informatics Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Stephanie Allan
- Glasgow Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Mario Alvarez-Jimenez
- Orygen Melbourne, Melbourne, VIC, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Lorna Aucott
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, UK
| | - Maximillian Birchwood
- Centre for Mental Health and Wellbeing Research, Warwick Medical School, University of Warwick, Warwick, UK
| | - Andrew Briggs
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Sue M Cotton
- Orygen Melbourne, Melbourne, VIC, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Lidia Engel
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Paul French
- Department of Psychiatry, Manchester Metropolitan University, Manchester, UK
| | - Reeva Lederman
- School of Computing and Information Systems, Faculty of Engineering and Information Technology, University of Melbourne, Melbourne, VIC, Australia
| | - Shôn Lewis
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Matthew Machin
- Division of Informatics Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Graeme MacLennan
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, UK
| | - Hamish McLeod
- Glasgow Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Nicola McMeekin
- Glasgow Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Cathy Mihalopoulos
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Emma Morton
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - John Norrie
- The Usher Institute, University of Edinburgh, Edinburgh, UK
| | | | - Swaran P Singh
- Centre for Mental Health and Wellbeing Research, Warwick Medical School, University of Warwick, Warwick, UK
| | - Suresh Sundram
- Department of Psychiatry, School of Clinical Sciences, Monash University, Melbourne, VIC, Australia; Mental Health Program, Monash Health, Melbourne, VIC, Australia
| | - Andrew Thompson
- Orygen Melbourne, Melbourne, VIC, Australia; Centre for Mental Health and Wellbeing Research, Warwick Medical School, University of Warwick, Warwick, UK
| | - Chris Williams
- Glasgow Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Alison R Yung
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK; School of Medicine, Deakin University, Melbourne, VIC, Australia
| | - John Farhall
- Department of Psychology and Counselling, La Trobe University, Melbourne, VIC, Australia; NorthWestern Mental Health, The Royal Melbourne Hospital, Epping, VIC, Australia
| | - John Gleeson
- Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC, Australia
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6
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Haining K, Gajwani R, Gross J, Gumley AI, Ince RAA, Lawrie SM, Schultze-Lutter F, Schwannauer M, Uhlhaas PJ. Characterising cognitive heterogeneity in individuals at clinical high-risk for psychosis: a cluster analysis with clinical and functional outcome prediction. Eur Arch Psychiatry Clin Neurosci 2022; 272:437-448. [PMID: 34401957 PMCID: PMC8938352 DOI: 10.1007/s00406-021-01315-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 07/26/2021] [Indexed: 12/24/2022]
Abstract
Schizophrenia is characterised by cognitive impairments that are already present during early stages, including in the clinical high-risk for psychosis (CHR-P) state and first-episode psychosis (FEP). Moreover, data suggest the presence of distinct cognitive subtypes during early-stage psychosis, with evidence for spared vs. impaired cognitive profiles that may be differentially associated with symptomatic and functional outcomes. Using cluster analysis, we sought to determine whether cognitive subgroups were associated with clinical and functional outcomes in CHR-P individuals. Data were available for 146 CHR-P participants of whom 122 completed a 6- and/or 12-month follow-up; 15 FEP participants; 47 participants not fulfilling CHR-P criteria (CHR-Ns); and 53 healthy controls (HCs). We performed hierarchical cluster analysis on principal components derived from neurocognitive and social cognitive measures. Within the CHR-P group, clusters were compared on clinical and functional variables and examined for associations with global functioning, persistent attenuated psychotic symptoms and transition to psychosis. Two discrete cognitive subgroups emerged across all participants: 45.9% of CHR-P individuals were cognitively impaired compared to 93.3% of FEP, 29.8% of CHR-N and 30.2% of HC participants. Cognitively impaired CHR-P participants also had significantly poorer functioning at baseline and follow-up than their cognitively spared counterparts. Specifically, cluster membership predicted functional but not clinical outcome. Our findings support the existence of distinct cognitive subgroups in CHR-P individuals that are associated with functional outcomes, with implications for early intervention and the understanding of underlying developmental processes.
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Affiliation(s)
- Kate Haining
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, UK
| | - Ruchika Gajwani
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Joachim Gross
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, UK
- Institute for Biomagnetism and Biosignalanalysis, University of Münster, Münster, Germany
| | - Andrew I Gumley
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Robin A A Ince
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, UK
| | - Stephen M Lawrie
- Department of Psychiatry, University of Edinburgh, Edinburgh, UK
| | - Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
- Department of Psychology and Mental Health, Faculty of Psychology, Airlangga University, Surabaya, Indonesia
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | | | - Peter J Uhlhaas
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, UK.
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany.
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7
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Brunner G, Gajwani R, Gross J, Gumley AI, Krishnadas R, Lawrie SM, Schwannauer M, Schultze-Lutter F, Fracasso A, Uhlhaas PJ. Hippocampal structural alterations in early-stage psychosis: Specificity and relationship to clinical outcomes. NeuroImage: Clinical 2022; 35:103087. [PMID: 35780662 PMCID: PMC9421451 DOI: 10.1016/j.nicl.2022.103087] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/09/2022] [Accepted: 06/13/2022] [Indexed: 11/30/2022] Open
Abstract
Individuals with early-stage psychosis show reduced hippocampal volumes. FEP show bilateral and widespread changes, while left hemisphere is affected in CHR-P. However, hippocampal changes do not show a relationship with clinical outcomes.
Hippocampal dysfunctions are a core feature of schizophrenia, but conflicting evidence exists whether volumetric and morphological changes are present in early-stage psychosis and to what extent these deficits are related to clinical trajectories. In this study, we recruited individuals at clinical high risk for psychosis (CHR-P) (n = 108), patients with a first episode of psychosis (FEP) (n = 37), healthy controls (HC) (n = 70) as well as a psychiatric control group with substance abuse and affective disorders (CHR-N: n = 38). MRI-data at baseline were obtained and volumetric as well as vertex analyses of the hippocampus were carried out. Moreover, volumetric changes were examined in the amygdala, caudate, nucleus accumbens, pallidum, putamen and thalamus. In addition, we obtained follow-up functional and symptomatic assessments in CHR-P individuals to examine the question whether anatomical deficits at baseline predicted clinical trajectories. Our results show that the hippocampus is the only structure showing significant volumetric decrease in early-stage psychosis, with FEPs showing significantly smaller hippocampal volumes bilaterally alongside widespread shape changes in the vertex analysis. For the CHR-P group, volumetric decreases were confined to the left hippocampus. However, hippocampal alterations in the CHR-P group were not robustly associated with clinical outcomes, including the persistence of attenuated psychotic symptoms and functional trajectories. Accordingly, our findings highlight that dysfunctions in hippocampal anatomy are an important feature of early-stage psychosis which may, however, not be related to clinical outcomes in CHR-P participants.
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Affiliation(s)
- Gina Brunner
- Institute for Neuroscience and Psychology, Univ. of Glasgow, UK
| | | | - Joachim Gross
- Institute for Neuroscience and Psychology, Univ. of Glasgow, UK; Institute of Biomagnetism and Biosignalanalysis, University of Muenster, Muenster, Germany
| | | | | | | | | | - Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany; Department of Psychology, Faculty of Psychology, Airlangga University, Airlangga, Indonesia; University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Switzerland
| | | | - Peter J Uhlhaas
- Institute for Neuroscience and Psychology, Univ. of Glasgow, UK; Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany.
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Grent-'t-Jong T, Gajwani R, Gross J, Gumley AI, Lawrie SM, Schwannauer M, Schultze-Lutter F, Williams SR, Uhlhaas PJ. MR-Spectroscopy of GABA and Glutamate/Glutamine Concentrations in Auditory Cortex in Clinical High-Risk for Psychosis Individuals. Front Psychiatry 2022; 13:859322. [PMID: 35422722 PMCID: PMC9002006 DOI: 10.3389/fpsyt.2022.859322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 02/21/2022] [Indexed: 11/28/2022] Open
Abstract
Psychosis involves changes in GABAergic and glutamatergic neurotransmission in auditory cortex that could be important for understanding sensory deficits and symptoms of psychosis. However, it is currently unclear whether such deficits are present in participants at clinical high-risk for psychosis (CHR-P) and whether they are associated with clinical outcomes. Magnetic Resonance Spectroscopy (MEGAPRESS, 1H-MRS at 3 Tesla) was used to estimate GABA, glutamate, and glutamate-plus-glutamine (Glx) levels in auditory cortex in a large sample of CHR-P (n = 99), CHR-N (clinical high-risk negative, n = 32), and 45 healthy controls. Examined were group differences in metabolite concentrations as well as relationships with clinical symptoms, general cognition, and 1-year follow-up clinical and general functioning in the CHR-P group. Results showed a marginal (p = 0.039) main group effect only for Glx, but not for GABA and glutamate concentrations, and only in left, not right, auditory cortex. This effect did not survive multiple comparison correction, however. Exploratory post-hoc tests revealed that there were significantly lower Glx levels (p = 0.029, uncorrected) in the CHR-P compared to the CHR-N group, but not relative to healthy controls (p = 0.058, uncorrected). Glx levels correlated with the severity of perceptual abnormalities and disorganized speech scores. However, in the CHR-P group, Glx levels did not predict clinical or functional outcomes. Accordingly, the findings from the present study suggest that MRS-measured GABA, glutamate and Glx levels in auditory cortex of CHR-P individuals are largely intact.
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Affiliation(s)
- Tineke Grent-'t-Jong
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, United Kingdom.,Department of Child and Adolescent Psychiatry, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ruchika Gajwani
- Mental Health and Wellbeing, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Joachim Gross
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, United Kingdom.,Institute for Biomagnetism and Biosignalanalysis, University of Münster, Münster, Germany
| | - Andrew I Gumley
- Mental Health and Wellbeing, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Stephen M Lawrie
- Department of Psychiatry, University of Edinburgh, Edinburgh, United Kingdom
| | - Matthias Schwannauer
- Department of Clinical Psychology, University of Edinburgh, Edinburgh, United Kingdom
| | - Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany.,Department of Psychology, Faculty of Psychology, Airlangga University, Surabaya, Indonesia.,University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Stephen R Williams
- Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Peter J Uhlhaas
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, United Kingdom.,Department of Child and Adolescent Psychiatry, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Haining K, Gajwani R, Gross J, Gumley AI, Ince RAA, Lawrie SM, Schultze-Lutter F, Schwannauer M, Uhlhaas PJ. Correction to: Characterising cognitive heterogeneity in individuals at clinical high-risk for psychosis: a cluster analysis with clinical and functional outcome prediction. Eur Arch Psychiatry Clin Neurosci 2022; 272:535-536. [PMID: 34519895 PMCID: PMC9172790 DOI: 10.1007/s00406-021-01330-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Kate Haining
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, UK
| | - Ruchika Gajwani
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Joachim Gross
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, UK
- Institute for Biomagnetism and Biosignalanalysis, University of Münster, Münster, Germany
| | - Andrew I Gumley
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Robin A A Ince
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, UK
| | - Stephen M Lawrie
- Department of Psychiatry, University of Edinburgh, Edinburgh, UK
| | - Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
- Department of Psychology and Mental Health, Faculty of Psychology, Airlangga University, Surabaya, Indonesia
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | | | - Peter J Uhlhaas
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, UK.
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany.
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10
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Haining K, Karagiorgou O, Gajwani R, Gross J, Gumley AI, Lawrie SM, Schwannauer M, Schultze-Lutter F, Uhlhaas PJ. Prevalence and predictors of suicidality and non-suicidal self-harm among individuals at clinical high-risk for psychosis: Results from a community-recruited sample. Early Interv Psychiatry 2021; 15:1256-1265. [PMID: 33372364 PMCID: PMC8451831 DOI: 10.1111/eip.13075] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/03/2020] [Accepted: 11/15/2020] [Indexed: 01/04/2023]
Abstract
AIM Suicidal thoughts and behaviours are prevalent in individuals with schizophrenia. However, research examining the prevalence and predictors of suicidality and self-harm in participants at clinical high-risk for psychosis (CHR-P) is limited and mostly focuses on help-seeking participants recruited through clinical pathways. The current study sought to assess the prevalence of suicidality and self-harm and identify predictors of current suicidal ideation in community-recruited CHR-P participants. METHODS Data were available for 130 CHR-P participants, 15 participants with first-episode psychosis (FEP), 47 participants not fulfilling CHR-P criteria (CHR-Ns) and 53 healthy controls. Current and lifetime suicidality and self-harm were assessed using the Mini-International Neuropsychiatric Interview and the Comprehensive Assessment of At-Risk Mental States (CAARMS). Multivariable logistic regression analysis was used to determine predictors of current suicidal ideation in the CHR-P group. RESULTS A considerable proportion of CHR-P participants disclosed current suicidal ideation (34.6%). Overall, FEP individuals were at greatest risk, with considerably high prevalence rates for current suicidal ideation (73.3%), lifetime self-harm behaviour (60.0%) and lifetime suicide attempt (60.0%). In the CHR-P sample, current suicidal ideation was predicted by lifetime suicide attempts, lower CAARMS severity, impaired social functioning and greater comorbidity. CONCLUSIONS Our findings suggest that suicidality and self-harm are highly prevalent in community-recruited CHR-P and FEP individuals. Accordingly, these results highlight the importance of further research into the determinants of suicidality and self-harm during at-risk and early stages of psychosis, and the implementation of intervention strategies to reduce adverse outcomes in these populations.
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Affiliation(s)
- Kate Haining
- Institute of Neuroscience and Psychology, University of Glasgow, Scotland, UK
| | - Olga Karagiorgou
- Institute of Neuroscience and Psychology, University of Glasgow, Scotland, UK
| | - Ruchika Gajwani
- Institute of Health and Wellbeing, University of Glasgow, Scotland, UK
| | - Joachim Gross
- Institute of Neuroscience and Psychology, University of Glasgow, Scotland, UK
| | - Andrew I Gumley
- Institute of Health and Wellbeing, University of Glasgow, Scotland, UK
| | - Stephen M Lawrie
- Department of Psychiatry, University of Edinburgh, Edinburgh, Scotland, UK
| | - Matthias Schwannauer
- Department of Clinical Psychology, University of Edinburgh, Edinburgh, Scotland, UK
| | - Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany.,Department of Psychology and Mental Health, Faculty of Psychology, Airlangga University, Surabaya, Indonesia.,University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Peter J Uhlhaas
- Institute of Neuroscience and Psychology, University of Glasgow, Scotland, UK.,Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
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Grent-'t-Jong T, Gajwani R, Gross J, Gumley AI, Krishnadas R, Lawrie SM, Schwannauer M, Schultze-Lutter F, Uhlhaas PJ. 40-Hz Auditory Steady-State Responses Characterize Circuit Dysfunctions and Predict Clinical Outcomes in Clinical High-Risk for Psychosis Participants: A Magnetoencephalography Study. Biol Psychiatry 2021; 90:419-429. [PMID: 34116790 DOI: 10.1016/j.biopsych.2021.03.018] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/02/2021] [Accepted: 03/17/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND This study aimed to examine whether 40-Hz auditory steady-state responses (ASSRs) are impaired in participants at clinical high-risk for psychosis (CHR-P) and predict clinical outcomes. METHODS Magnetoencephalography data were collected during a 40-Hz ASSR paradigm for a group of 116 CHR-P participants, 33 patients with first-episode psychosis (15 antipsychotic-naïve), a psychosis risk-negative group (n = 38), and 49 healthy control subjects. Analysis of group differences of 40-Hz intertrial phase coherence and 40-Hz amplitude focused on right Heschl's gyrus, superior temporal gyrus, hippocampus, and thalamus after establishing significant activations during 40-Hz ASSR stimulation. Linear regression and linear discriminant analyses were used to predict clinical outcomes in CHR-P participants, including transition to psychosis and persistence of attenuated psychotic symptoms (APSs). RESULTS CHR-P participants and patients with first-episode psychosis were impaired in 40-Hz amplitude in the right thalamus and hippocampus. In addition, patients with first-episode psychosis were impaired in 40-Hz amplitude in the right Heschl's gyrus, and CHR-P participants in 40-Hz intertrial phase coherence in the right Heschl's gyrus. The 40-Hz ASSR deficits were pronounced in CHR-P participants who later transitioned to psychosis (n = 13) or showed persistent APSs (n = 34). Importantly, both APS persistence and transition to psychosis were predicted by 40-Hz ASSR impairments, with ASSR activity in the right hippocampus, superior temporal gyrus, and middle temporal gyrus correctly classifying 69.2% individuals with nonpersistent APSs and 73.5% individuals with persistent APSs (area under the curve = 0.842), and right thalamus 40-Hz activity correctly classifying 76.9% transitioned and 53.6% nontransitioned CHR-P participants (area under the curve = 0.695). CONCLUSIONS Our data indicate that deficits in gamma-band entrainment in the primary auditory cortex and subcortical areas constitute a potential biomarker for predicting clinical outcomes in CHR-P participants.
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Affiliation(s)
- Tineke Grent-'t-Jong
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, United Kingdom; Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Ruchika Gajwani
- Mental Health and Wellbeing, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Joachim Gross
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, United Kingdom; Institute for Biomagnetism and Biosignalanalysis, University of Muenster, Muenster, Germany
| | - Andrew I Gumley
- Mental Health and Wellbeing, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Rajeev Krishnadas
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, United Kingdom
| | - Stephen M Lawrie
- Department of Psychiatry, University of Edinburgh, Edinburgh, United Kingdom
| | - Matthias Schwannauer
- Department of Clinical Psychology, University of Edinburgh, Edinburgh, United Kingdom
| | - Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany; Department of Psychology and Mental Health, Faculty of Psychology, Airlangga University, Airlangga, Indonesia; University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Peter J Uhlhaas
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, United Kingdom; Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany.
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12
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Staines L, Gajwani R, Gross J, Gumley AI, Lawrie SM, Schwannauer M, Schultze-Lutter F, Uhlhaas PJ. Duration of basic and attenuated-psychotic symptoms in individuals at clinical high risk for psychosis: pattern of symptom onset and effects of duration on functioning and cognition. BMC Psychiatry 2021; 21:339. [PMID: 34233651 PMCID: PMC8265048 DOI: 10.1186/s12888-021-03267-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 05/04/2021] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Duration of risk symptoms (DUR) in people at clinical high risk for psychosis (CHR-P) has been related to poorer clinical outcomes, such as reduced functioning, but it is currently unclear how different symptoms emerge as well as their link with cognitive deficits. To address these questions, we examined the duration of basic symptoms (BS) and attenuated psychotic symptoms (APS) in a sample of CHR-P participants to test the hypothesis that BS precede the manifestation of APS. As a secondary objective, we investigated the relationship between DUR, functioning and neuropsychological deficits. METHODS Data from 134 CHR-P participants were assessed with the Comprehensive Assessment of At-Risk Mental State and the Schizophrenia Proneness Interview, Adult Version. Global, role and social functioning and neurocognition were assessed and compared to a sample of healthy controls (n = 57). RESULTS In CHR-P participants who reported both APS and BS, onset of BS and APS was not significantly related. When divided into short and long BS duration (</> 8 years), CHR-P participants with a longer duration of BS showed evidence for an onset of BS preceding APS (n = 8, p = 0.003). However, in the short BS duration group, APS showed evidence of preceding BS (n = 56, p = 0.020). Finally, there were no significant effects of DUR on cognition or functioning measures. CONCLUSION The present findings do not support the view that APS constitute a secondary phenomenon to BS. Moreover, our data could also not confirm that DUR has a significant effect on functioning and cognitive deficits. These findings are discussed in the context of current theories regarding emerging psychosis and the importance of DUR.
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Affiliation(s)
- Lorna Staines
- Institute for Neuroscience and Psychology, University of Glasgow, Glasgow, UK.,Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Ruchika Gajwani
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Joachim Gross
- Institute for Neuroscience and Psychology, University of Glasgow, Glasgow, UK.,Institute for Biomagnetism and Biosignalanalysis, University of Muenster, Muenster, Germany
| | - Andrew I Gumley
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Stephen M Lawrie
- Department of Psychiatry, University of Edinburgh, Edinburgh, UK
| | | | - Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany.,Department of Psychology and Mental Health, Faculty of Psychology, Airlangga University, Surabaya, Indonesia.,University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Peter J Uhlhaas
- Institute for Neuroscience and Psychology, University of Glasgow, Glasgow, UK. .,Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany.
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13
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Haining K, Brunner G, Gajwani R, Gross J, Gumley AI, Lawrie SM, Schwannauer M, Schultze-Lutter F, Uhlhaas PJ. The relationship between cognitive deficits and impaired short-term functional outcome in clinical high-risk for psychosis participants: A machine learning and modelling approach. Schizophr Res 2021; 231:24-31. [PMID: 33744682 DOI: 10.1016/j.schres.2021.02.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 09/08/2020] [Accepted: 02/27/2021] [Indexed: 11/29/2022]
Abstract
Poor functional outcomes are common in individuals at clinical high-risk for psychosis (CHR-P), but the contribution of cognitive deficits remains unclear. We examined the potential utility of cognitive variables in predictive models of functioning at baseline and follow-up with machine learning methods. Additional models fitted on baseline functioning variables were used as a benchmark to evaluate model performance. Data were available for 1) 146 CHR-P individuals of whom 118 completed a 6- and/or 12-month follow-up, 2) 47 participants not fulfilling CHR criteria (CHR-Ns) but displaying affective and substance use disorders and 3) 55 healthy controls (HCs). Predictors of baseline global assessment of functioning (GAF) scores were selected by L1-regularised least angle regression and then used to train classifiers to predict functional outcome in CHR-P individuals. In CHR-P participants, cognitive deficits together with clinical and functioning variables explained 41% of the variance in baseline GAF scores while cognitive variables alone explained 12%. These variables allowed classification of functional outcome with an average balanced accuracy (BAC) of 63% in both mixed- and cross-site models. However, higher accuracies (68%-70%) were achieved using classifiers fitted only on baseline functioning variables. Our findings suggest that cognitive deficits, alongside clinical and functioning variables, displayed robust relationships with impaired functioning in CHR-P participants at baseline and follow-up. Moreover, these variables allow for prediction of functional outcome. However, models based on baseline functioning variables showed a similar performance, highlighting the need to develop more accurate algorithms for predicting functional outcome in CHR-P participants.
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Affiliation(s)
- Kate Haining
- Institute for Neuroscience and Psychology, Univ. of Glasgow, United Kingdom of Great Britain and Northern Ireland
| | - Gina Brunner
- Institute for Neuroscience and Psychology, Univ. of Glasgow, United Kingdom of Great Britain and Northern Ireland
| | - Ruchika Gajwani
- Institute of Health and Wellbeing, Univ. of Glasgow, United Kingdom of Great Britain and Northern Ireland
| | - Joachim Gross
- Institute for Neuroscience and Psychology, Univ. of Glasgow, United Kingdom of Great Britain and Northern Ireland
| | - Andrew I Gumley
- Institute of Health and Wellbeing, Univ. of Glasgow, United Kingdom of Great Britain and Northern Ireland
| | - Stephen M Lawrie
- Department of Psychiatry, Univ. of Edinburgh, United Kingdom of Great Britain and Northern Ireland
| | - Matthias Schwannauer
- Department of Clinical Psychology, Univ. Edinburgh, United Kingdom of Great Britain and Northern Ireland
| | - Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany; Department of Psychology and Mental Health, Faculty of Psychology, Airlangga University, Airlangga 4-6, Surabaya 60286, Indonesia; University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstr. 111, 3000 Bern 60, Switzerland
| | - Peter J Uhlhaas
- Institute for Neuroscience and Psychology, Univ. of Glasgow, United Kingdom of Great Britain and Northern Ireland; Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany.
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Kocsis A, Gajwani R, Gross J, Gumley AI, Lawrie SM, Schwannauer M, Schultze-Lutter F, Grent-‘t-Jong T, Uhlhaas PJ. Altered Autonomic Function in Individuals at Clinical High Risk for Psychosis. Front Psychiatry 2020; 11:580503. [PMID: 33240132 PMCID: PMC7677235 DOI: 10.3389/fpsyt.2020.580503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 09/11/2020] [Indexed: 11/22/2022] Open
Abstract
Introduction: Alterations in autonomic functioning in individuals diagnosed with schizophrenia are well-documented. Yet, it is currently unclear whether these dysfunctions extend into the clinical high-risk state. Thus, we investigated resting heart rate (RHR) and heart rate variability (HRV) indices in individuals at clinical high-risk for psychosis (CHR-P). Methods: We recruited 117 CHR-P participants, 38 participants with affective disorders and substance abuse (CHR-N) as well as a group of 49 healthy controls. CHR-P status was assessed with the Comprehensive Assessment of At-Risk Mental States (CAARMS) and the Schizophrenia Proneness Instrument, Adult Version (SPI-A). We obtained 5 min, eyes-open resting-state MEG data, which was used for the extraction of cardiac field-related inter-beat-interval data and from which heart-rate and heart-rate variability measures were computed. Results: Compared to both CHR-N and healthy controls, CHR-P participants were characterized by an increased RHR, which was not explained by differences in psychopathological comorbidity and medication status. Increased RHR correlated with the presence of subthreshold psychotic symptoms and associated distress. No differences between groups were found for heart-rate variability measures, however. Furthermore, there was an association between motor-performance and psychophysiological measures. Conclusion: The current study provides evidence of alterations in autonomic functioning as disclosed by increased RHR in CHR-P participants. Future studies are needed to further evaluate this characteristic feature of CHR-P individuals and its potential predictive value for psychosis development.
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Affiliation(s)
- Anna Kocsis
- Institute for Neuroscience and Psychology, University of Glasgow, Glasgow, United Kingdom
- Department of Experimental Psychology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Ruchika Gajwani
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Joachim Gross
- Institute for Neuroscience and Psychology, University of Glasgow, Glasgow, United Kingdom
| | - Andrew I. Gumley
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Stephen M. Lawrie
- Department of Psychiatry, University of Edinburgh, Edinburgh, United Kingdom
| | - Matthias Schwannauer
- Department of Clinical Psychology, University Edinburgh, Edinburgh, United Kingdom
| | - Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
- Department of Psychology and Mental Health, Faculty of Psychology, Airlangga University, Surabaya, Indonesia
| | - Tineke Grent-‘t-Jong
- Institute for Neuroscience and Psychology, University of Glasgow, Glasgow, United Kingdom
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Peter J. Uhlhaas
- Institute for Neuroscience and Psychology, University of Glasgow, Glasgow, United Kingdom
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
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Grent-‘t-Jong T, Gajwani R, Gross J, Gumley AI, Krishnadas R, Lawrie SM, Schwannauer M, Schultze-Lutter F, Uhlhaas PJ. Association of Magnetoencephalographically Measured High-Frequency Oscillations in Visual Cortex With Circuit Dysfunctions in Local and Large-scale Networks During Emerging Psychosis. JAMA Psychiatry 2020; 77:852-862. [PMID: 32211834 PMCID: PMC7097849 DOI: 10.1001/jamapsychiatry.2020.0284] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
IMPORTANCE Psychotic disorders are characterized by impairments in neural oscillations, but the nature of the deficit, the trajectory across illness stages, and functional relevance remain unclear. OBJECTIVES To examine whether changes in spectral power, phase locking, and functional connectivity in visual cortex are present during emerging psychosis and whether these abnormalities are associated with clinical outcomes. DESIGN, SETTING, AND PARTICIPANTS In this cross-sectional study, participants meeting clinical high-risk criteria for psychosis, participants with first-episode psychosis, participants with affective disorders and substance abuse, and a group of control participants were recruited. Participants underwent measurements with magnetoencephalography and magnetic resonance imaging. Data analysis was carried out between 2018 and 2019. MAIN OUTCOMES AND MEASURES Magnetoencephalographical activity was examined in the 1- to 90-Hz frequency range in combination with source reconstruction during a visual grating task. Event-related fields, power modulation, intertrial phase consistency, and connectivity measures in visual and frontal cortices were associated with neuropsychological scores, psychosocial functioning, and clinical symptoms as well as persistence of subthreshold psychotic symptoms at 12 months. RESULTS The study participants included those meeting clinical high-risk criteria for psychosis (n = 119; mean [SD] age, 22 [4.4] years; 32 men), 26 patients with first-episode psychosis (mean [SD] age, 24 [4.2] years; 16 men), 38 participants with affective disorders and substance abuse (mean [SD] age, 23 [4.7] years; 11 men), and 49 control participants (mean age [SD], 23 [3.6] years; 16 men). Clinical high-risk participants and patients with first-episode psychosis were characterized by reduced phase consistency of β/γ-band oscillations in visual cortex (d = 0.63/d = 0.93). Moreover, the first-episode psychosis group was also characterized by reduced occipital γ-band power (d = 1.14) and altered visual cortex connectivity (d = 0.74-0.84). Impaired fronto-occipital connectivity was present in both clinical high-risk participants (d = 0.54) and patients with first-episode psychosis (d = 0.84). Importantly, reductions in intertrial phase coherence predicted persistence of subthreshold psychosis in clinical high-risk participants (receiver operating characteristic area under curve = 0.728; 95% CI, 0.612-0.841; P = .001). CONCLUSIONS AND RELEVANCE High-frequency oscillations are impaired in the visual cortex during emerging psychosis and may be linked to behavioral and clinical impairments. Impaired phase consistency of γ-band oscillations was also associated with the persistence of subthreshold psychosis, suggesting that magnetoencephalographical measured neural oscillations could constitute a biomarker for clinical staging of emerging psychosis.
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Affiliation(s)
- Tineke Grent-‘t-Jong
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, Scotland,Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Ruchika Gajwani
- Mental Health and Wellbeing, Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Joachim Gross
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, Scotland,Institute for Biomagnetism and Biosignalanalysis, University of Muenster, Muenster, Germany
| | - Andrew I. Gumley
- Mental Health and Wellbeing, Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Rajeev Krishnadas
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, Scotland
| | - Stephen M. Lawrie
- Department of Psychiatry, University of Edinburgh, Edinburgh, Scotland
| | | | - Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich Heine University, üsseldorf, Bergische Landstrasse 2, 40629 Düsseldorf, Germany
| | - Peter J. Uhlhaas
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, Scotland,Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
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Haining K, Matrunola C, Mitchell L, Gajwani R, Gross J, Gumley AI, Lawrie SM, Schwannauer M, Schultze-Lutter F, Uhlhaas PJ. Neuropsychological deficits in participants at clinical high risk for psychosis recruited from the community: relationships to functioning and clinical symptoms. Psychol Med 2020; 50:77-85. [PMID: 30862319 PMCID: PMC6949121 DOI: 10.1017/s0033291718003975] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The current study examined the pattern of neurocognitive impairments in a community-recruited sample of clinical high-risk (CHR) participants and established relationships with psychosocial functioning. METHODS CHR-participants (n = 108), participants who did not fulfil CHR-criteria (CHR-negatives) (n = 42) as well as a group of healthy controls (HCs) (n = 55) were recruited. CHR-status was assessed using the Comprehensive Assessment of At-Risk Mental States (CAARMS) and the Schizophrenia Proneness Instrument, Adult Version (SPI-A). The Brief Assessment of Cognition in Schizophrenia Battery (BACS) as well as tests for emotion recognition, working memory and attention were administered. In addition, role and social functioning as well as premorbid adjustment were assessed. RESULTS CHR-participants were significantly impaired on the Symbol-Coding and Token-Motor task and showed a reduction in total BACS-scores. Moreover, CHR-participants were characterised by prolonged response times (RTs) in emotion recognition as well as by reductions in both social and role functioning, GAF and premorbid adjustments compared with HCs. Neurocognitive impairments in emotion recognition accuracy, emotion recognition RT, processing speed and motor speed were associated with several aspects of functioning explaining between 4% and 12% of the variance. CONCLUSION The current data obtained from a community sample of CHR-participants highlight the importance of dysfunctions in motor and processing speed and emotion recognition RT. Moreover, these deficits were found to be related to global, social and role functioning, suggesting that neurocognitive impairments are an important aspect of sub-threshold psychotic experiences and a possible target for therapeutic interventions.
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Affiliation(s)
- Kate Haining
- Institute for Neuroscience and Psychology, Univ. of Glasgow, U.K
| | - Claire Matrunola
- Institute for Neuroscience and Psychology, Univ. of Glasgow, U.K
| | - Lucy Mitchell
- Institute for Neuroscience and Psychology, Univ. of Glasgow, U.K
| | - Ruchika Gajwani
- Institute of Biomagnetism and Biosignalanalysis, Westphalian Wilhelms University Muenster, Germany
| | - Joachim Gross
- Institute for Neuroscience and Psychology, Univ. of Glasgow, U.K
- Institute of Biomagnetism and Biosignalanalysis, Westphalian Wilhelms University Muenster, Germany
| | | | | | | | - Frauke Schultze-Lutter
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, Univ. of Bern, Bern, Switzerland
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich Heine University Düsseldorf, Germany
| | - Peter J. Uhlhaas
- Institute for Neuroscience and Psychology, Univ. of Glasgow, U.K
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Allan S, Bradstreet S, McLeod HJ, Gleeson J, Farhall J, Lambrou M, Clark A, Gumley AI. Perspectives of patients, carers and mental health staff on early warning signs of relapse in psychosis: a qualitative investigation. BJPsych Open 2019; 6:e3. [PMID: 31826793 PMCID: PMC7001464 DOI: 10.1192/bjo.2019.88] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Relapse prevention strategies based on monitoring of early warning signs (EWS) are advocated for the management of psychosis. However, there has been a lack of research exploring how staff, carers and patients make sense of the utility of EWS, or how these are implemented in context. AIMS To develop a multiperspective theory of how EWS are understood and used, which is grounded in the experiences of mental health staff, carers and patients. METHOD Twenty-five focus groups were held across Glasgow and Melbourne (EMPOWER Trial, ISRCTN: 99559262). Participants comprised 88 mental health staff, 21 patients and 40 carers from UK and Australia (total n = 149). Data were analysed using constructivist grounded theory. RESULTS All participants appeared to recognise EWS and acknowledged the importance of responding to EWS to support relapse prevention. However, recognition of and acting on EWS were constructed in a context of uncertainty, which appeared linked to risk appraisals that were dependent on distinct stakeholder roles and experiences. Within current relapse management, a process of weighted decision-making (where one factor was seen as more important than others) described how stakeholders weighed up the risks and consequences of relapse alongside the risks and consequences of intervention and help-seeking. CONCLUSIONS Mental health staff, carers and patients speak about using EWS within a weighted decision-making process, which is acted out in the context of relationships that exist in current relapse management, rather than an objective response to specific signs and symptoms.
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Affiliation(s)
- Stephanie Allan
- Student, Glasgow Institute of Health and Wellbeing, University of Glasgow, UK
| | - Simon Bradstreet
- Trial Manager, Glasgow Institute of Health and Wellbeing, University of Glasgow, UK
| | - Hamish J McLeod
- Professor, Glasgow Institute of Health and Wellbeing, University of Glasgow, UK
| | - John Gleeson
- Professor, Australian Catholic University, Australia
| | - John Farhall
- Associate Professor, La Trobe University, Australia
| | - Maria Lambrou
- Research Assistant, Australian Catholic University, Australia
| | - Andrea Clark
- Research Assistant, Glasgow Institute of Health and Wellbeing, University of Glasgow, UK
| | - Andrew I Gumley
- Professor, Glasgow Institute of Health and Wellbeing, University of Glasgow, UK
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18
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Leighton SP, Upthegrove R, Krishnadas R, Benros ME, Broome MR, Gkoutos GV, Liddle PF, Singh SP, Everard L, Jones PB, Fowler D, Sharma V, Freemantle N, Christensen RHB, Albert N, Nordentoft M, Schwannauer M, Cavanagh J, Gumley AI, Birchwood M, Mallikarjun PK. Development and validation of multivariable prediction models of remission, recovery, and quality of life outcomes in people with first episode psychosis: a machine learning approach. Lancet Digit Health 2019; 1:e261-e270. [PMID: 33323250 DOI: 10.1016/s2589-7500(19)30121-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 08/12/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Outcomes for people with first-episode psychosis are highly heterogeneous. Few reliable validated methods are available to predict the outcome for individual patients in the first clinical contact. In this study, we aimed to build multivariable prediction models of 1-year remission and recovery outcomes using baseline clinical variables in people with first-episode psychosis. METHODS In this machine learning approach, we applied supervised machine learning, using regularised regression and nested leave-one-site-out cross-validation, to baseline clinical data from the English Evaluating the Development and Impact of Early Intervention Services (EDEN) study (n=1027), to develop and internally validate prediction models at 1-year follow-up. We assessed four binary outcomes that were recorded at 1 year: symptom remission, social recovery, vocational recovery, and quality of life (QoL). We externally validated the prediction models by selecting from the top predictor variables identified in the internal validation models the variables shared with the external validation datasets comprised of two Scottish longitudinal cohort studies (n=162) and the OPUS trial, a randomised controlled trial of specialised assertive intervention versus standard treatment (n=578). FINDINGS The performance of prediction models was robust for the four 1-year outcomes of symptom remission (area under the receiver operating characteristic curve [AUC] 0·703, 95% CI 0·664-0·742), social recovery (0·731, 0·697-0·765), vocational recovery (0·736, 0·702-0·771), and QoL (0·704, 0·667-0·742; p<0·0001 for all outcomes), on internal validation. We externally validated the outcomes of symptom remission (AUC 0·680, 95% CI 0·587-0·773), vocational recovery (0·867, 0·805-0·930), and QoL (0·679, 0·522-0·836) in the Scottish datasets, and symptom remission (0·616, 0·553-0·679), social recovery (0·573, 0·504-0·643), vocational recovery (0·660, 0·610-0·710), and QoL (0·556, 0·481-0·631) in the OPUS dataset. INTERPRETATION In our machine learning analysis, we showed that prediction models can reliably and prospectively identify poor remission and recovery outcomes at 1 year for patients with first-episode psychosis using baseline clinical variables at first clinical contact. FUNDING Lundbeck Foundation.
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Affiliation(s)
- Samuel P Leighton
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Rachel Upthegrove
- Institute for Mental Health, University of Birmingham, Birmingham, UK
| | - Rajeev Krishnadas
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, UK
| | - Michael E Benros
- Copenhagen Research Center for Mental Health, Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Matthew R Broome
- Institute for Mental Health, University of Birmingham, Birmingham, UK
| | - Georgios V Gkoutos
- Institute of Cancer and Genomics, University of Birmingham, Birmingham, UK; Institute of Translational Medicine, University of Birmingham, Birmingham, UK; Health Data Research UK Midlands, UK; University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Peter F Liddle
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Swaran P Singh
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Peter B Jones
- Wolfson College, University of Cambridge, Cambridge, UK
| | - David Fowler
- School of Psychology, University of Sussex, Brighton, UK
| | - Vimal Sharma
- Department of Health and Social Care, University of Chester, Chester, UK
| | | | - Rune H B Christensen
- Copenhagen Research Center for Mental Health, Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Nikolai Albert
- Copenhagen Research Center for Mental Health, Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Merete Nordentoft
- Copenhagen Research Center for Mental Health, Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Matthias Schwannauer
- School of Health in Social Science, Clinical Psychology, University of Edinburgh, Edinburgh, UK
| | - Jonathan Cavanagh
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Andrew I Gumley
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Max Birchwood
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
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McDonald M, Christoforidou E, Van Rijsbergen N, Gajwani R, Gross J, Gumley AI, Lawrie SM, Schwannauer M, Schultze-Lutter F, Uhlhaas PJ. Using Online Screening in the General Population to Detect Participants at Clinical High-Risk for Psychosis. Schizophr Bull 2019; 45:600-609. [PMID: 29889271 PMCID: PMC6483579 DOI: 10.1093/schbul/sby069] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Identification of participants at clinical high-risk (CHR) for the development of psychosis is an important objective of current preventive efforts in mental health research. However, the utility of using web-based screening approaches to detect CHR participants at the population level has not been investigated. METHODS We tested a web-based screening approach to identify CHR individuals. Potential participants were invited to a website via e-mail invitations, flyers, and invitation letters involving both the general population and mental health services. Two thousand two hundred seventy-nine participants completed the 16-item version of the prodromal questionnaire (PQ-16) and a 9-item questionnaire of perceptual and cognitive aberrations (PCA) for the assessment of basic symptoms (BS) online. 52.3% of participants met a priori cut-off criteria for the PQ and 73.6% for PCA items online. One thousand seven hundred eighty-seven participants were invited for a clinical interview and n = 356 interviews were conducted (response rate: 19.9%) using the Comprehensive Assessment of At-Risk Mental State (CAARMS) and the Schizophrenia Proneness Interview, Adult Version (SPI-A). n = 101 CHR participants and n = 8 first-episode psychosis (FEP) were detected. ROC curve analysis revealed good to moderate sensitivity and specificity for predicting CHR status based on online results for both UHR and BS criteria (sensitivity/specificity: PQ-16 = 82%/46%; PCA = 94%/12%). Selection of a subset of 10 items from both PQ-16 and PCA lead to an improved of specificity of 57% while only marginally affecting sensitivity (81%). CHR participants were characterized by similar levels of functioning and neurocognitive deficits as clinically identified CHR groups. CONCLUSION These data provide evidence for the possibility to identify CHR participants through population-based web screening. This could be an important strategy for early intervention and diagnosis of psychotic disorders.
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Affiliation(s)
- Mhairi McDonald
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, UK
| | | | | | - Ruchika Gajwani
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Joachim Gross
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, UK,Institute for Biomagnetism and Biosignalanalysis, University of Muenster, Germany
| | - Andrew I Gumley
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Stephen M Lawrie
- Department of Psychiatry, University of Edinburgh, Edinburgh, UK
| | | | - Frauke Schultze-Lutter
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland,Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Peter J Uhlhaas
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, UK,To whom correspondence should be addressed; Institute of Neuroscience and Psychology, University of Glasgow, 58 Hillhead Street, Glasgow G12 8QB, UK; tel: 0044-141-330-8730; fax: 0141-330-4606, e-mail:
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20
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Leighton SP, Krishnadas R, Chung K, Blair A, Brown S, Clark S, Sowerbutts K, Schwannauer M, Cavanagh J, Gumley AI. Predicting one-year outcome in first episode psychosis using machine learning. PLoS One 2019; 14:e0212846. [PMID: 30845268 PMCID: PMC6405084 DOI: 10.1371/journal.pone.0212846] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 02/11/2019] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Early illness course correlates with long-term outcome in psychosis. Accurate prediction could allow more focused intervention. Earlier intervention corresponds to significantly better symptomatic and functional outcomes. Our study objective is to use routinely collected baseline demographic and clinical characteristics to predict employment, education or training (EET) status, and symptom remission in patients with first episode psychosis (FEP) at one-year. METHODS AND FINDINGS 83 FEP patients were recruited from National Health Service (NHS) Glasgow between 2011 and 2014 to a 24-month prospective cohort study with regular assessment of demographic and psychometric measures. An external independent cohort of 79 FEP patients were recruited from NHS Glasgow and Edinburgh during a 12-month study between 2006 and 2009. Elastic net regularised logistic regression models were built to predict binary EET status, period and point remission outcomes at one-year on 83 Glasgow patients (training dataset). Models were externally validated on an independent dataset of 79 patients from Glasgow and Edinburgh (validation dataset). Only baseline predictors shared across both cohorts were made available for model training and validation. After excluding participants with missing outcomes, models were built on the training dataset for EET status, period and point remission outcomes and externally validated on the validation dataset. Models predicted EET status, period and point remission with receiver operating curve (ROC) area under the curve (AUC) performances of 0.876 (95%CI: 0.864, 0.887), 0.630 (95%CI: 0.612, 0.647) and 0.652 (95%CI: 0.635, 0.670) respectively. Positive predictors of EET included baseline EET and living with spouse/children. Negative predictors included higher PANSS suspiciousness, hostility and delusions scores. Positive predictors for symptom remission included living with spouse/children, and affective symptoms on the Positive and Negative Syndrome Scale (PANSS). Negative predictors of remission included passive social withdrawal symptoms on PANSS. A key limitation of this study is the small sample size (n) relative to the number of predictors (p), whereby p approaches n. The use of elastic net regularised regression rather than ordinary least squares regression helped circumvent this difficulty. Further, we did not have information for biological and additional social variables, such as nicotine dependence, which observational studies have linked to outcomes in psychosis. CONCLUSIONS AND RELEVANCE Using advanced statistical machine learning techniques, we provide the first externally validated evidence, in a temporally and geographically independent cohort, for the ability to predict one-year EET status and symptom remission in individual FEP patients.
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Affiliation(s)
- Samuel P. Leighton
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Rajeev Krishnadas
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, United Kingdom
- ESTEEM First Episode Psychosis Service, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Kelly Chung
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Alison Blair
- ESTEEM First Episode Psychosis Service, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Susie Brown
- ESTEEM First Episode Psychosis Service, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Suzy Clark
- ESTEEM First Episode Psychosis Service, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Kathryn Sowerbutts
- ESTEEM First Episode Psychosis Service, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Matthias Schwannauer
- Department of Clinical & Health Psychology, University of Edinburgh, Edinburgh, United Kingdom
| | - Jonathan Cavanagh
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Andrew I. Gumley
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
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Grent-'t-Jong T, Gross J, Goense J, Wibral M, Gajwani R, Gumley AI, Lawrie SM, Schwannauer M, Schultze-Lutter F, Navarro Schröder T, Koethe D, Leweke FM, Singer W, Uhlhaas PJ. Resting-state gamma-band power alterations in schizophrenia reveal E/I-balance abnormalities across illness-stages. eLife 2018; 7:37799. [PMID: 30260771 PMCID: PMC6160226 DOI: 10.7554/elife.37799] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 08/30/2018] [Indexed: 12/31/2022] Open
Abstract
We examined alterations in E/I-balance in schizophrenia (ScZ) through measurements of resting-state gamma-band activity in participants meeting clinical high-risk (CHR) criteria (n = 88), 21 first episode (FEP) patients and 34 chronic ScZ-patients. Furthermore, MRS-data were obtained in CHR-participants and matched controls. Magnetoencephalographic (MEG) resting-state activity was examined at source level and MEG-data were correlated with neuropsychological scores and clinical symptoms. CHR-participants were characterized by increased 64–90 Hz power. In contrast, FEP- and ScZ-patients showed aberrant spectral power at both low- and high gamma-band frequencies. MRS-data showed a shift in E/I-balance toward increased excitation in CHR-participants, which correlated with increased occipital gamma-band power. Finally, neuropsychological deficits and clinical symptoms in FEP and ScZ-patients were correlated with reduced gamma band-activity, while elevated psychotic symptoms in the CHR group showed the opposite relationship. The current study suggests that resting-state gamma-band power and altered Glx/GABA ratio indicate changes in E/I-balance parameters across illness stages in ScZ.
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Affiliation(s)
- Tineke Grent-'t-Jong
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, United Kingdom
| | - Joachim Gross
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, United Kingdom.,Institute for Biomagnetism and Biosignalanalysis, University of Muenster, Muenster, Germany
| | - Jozien Goense
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, United Kingdom
| | | | - Ruchika Gajwani
- Mental Health and Wellbeing, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Andrew I Gumley
- Mental Health and Wellbeing, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Stephen M Lawrie
- Department of Psychiatry, University of Edinburgh, Edinburgh, United Kingdom
| | - Matthias Schwannauer
- Department of Clinical Psychology, University Edinburgh, Edinburgh, United Kingdom
| | - Frauke Schultze-Lutter
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.,Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Tobias Navarro Schröder
- Kavli Institute for Systems Neuroscience and Centre for Neural Computation, Norwegian University of Science and Technology, Trondheim, Norway
| | - Dagmar Koethe
- Department of Psychosomatics and Psychotherapeutic Medicine, Central Institute of Mental health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - F Markus Leweke
- Department of Psychosomatics and Psychotherapeutic Medicine, Central Institute of Mental health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Brain and Mind Centre, University of Sydney, Sydney, Australia.,Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Wolf Singer
- Department of Neurophysiology, Max Planck Institute for Brain Research, Frankfurt am Main, Germany.,Ernst Strüngmann Institute for Neuroscience and the Max Planck Society, Frankfurt am Main, Germany.,Frankfurt Institute for Advanced Studies, Frankfurt am Main, Germany
| | - Peter J Uhlhaas
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, United Kingdom
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22
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Murphy EK, Tully S, Pyle M, Gumley AI, Kingdon D, Schwannauer M, Turkington D, Morrison AP. The Beliefs about Paranoia Scale: Confirmatory factor analysis and tests of a metacognitive model of paranoia in a clinical sample. Psychiatry Res 2017; 248:87-94. [PMID: 28033512 DOI: 10.1016/j.psychres.2016.11.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Revised: 09/13/2016] [Accepted: 11/02/2016] [Indexed: 11/16/2022]
Abstract
This study aimed to confirm the factor structure of the Beliefs about Paranoia Scale (BaPS), a self-report measure to assess metacognitive beliefs about paranoia, and to test hypotheses of a metacognitive model. We hypothesised that positive and negative beliefs about paranoia would be associated with severity of suspiciousness, and that the co-occurrence of positive and negative beliefs would be associated with increased suspiciousness. A total of 335 patients meeting criteria for a schizophrenia spectrum disorder completed the BaPS, the Positive and Negative Syndromes Scale (PANSS), and the Psychotic Symptom Rating Scales (PSYRATS). Confirmatory factor analysis verified that the three BaPS subscales (negative beliefs about paranoia, paranoia as a survival strategy, and normalizing beliefs) were an adequate fit of the data. Ordinal regression showed that positive beliefs about paranoia as a survival strategy and negative beliefs were both associated with severity of suspiciousness. This was the first study to show that the co-occurrence of positive and negative beliefs was associated with increased suspiciousness. All hypotheses were confirmed, suggesting that a metacognitive approach has utility for the conceptualization of paranoia. Clinical implications suggest a role for metacognitive therapy, including strategies such as detached mindfulness and worry postponement.
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Affiliation(s)
| | - Sarah Tully
- Psychosis Research Unit, Greater Manchester West NHS Trust, UK
| | - Melissa Pyle
- Psychosis Research Unit, Greater Manchester West NHS Trust, UK; School of Psychological Sciences, University of Manchester, UK
| | - Andrew I Gumley
- Institute of Health and Wellbeing, University of Glasgow, UK
| | | | | | | | - Anthony P Morrison
- Psychosis Research Unit, Greater Manchester West NHS Trust, UK; School of Psychological Sciences, University of Manchester, UK
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Abstract
BACKGROUND The transition from adolescence to adulthood is associated with the emergence of psychosis and other mental health problems, highlighting the importance of this developmental period for the understanding of developing psychopathology and individual differences in risk and resilience. The Youth Mental Health Risk and Resilience Study (YouR-Study) aims to identify neurobiological mechanisms and predictors of psychosis-risk with a state-of-the-art neuroimaging approach (Magnetoencephalography, Magnetic Resonance Spectroscopy, Magnetic Resonance Imaging) in combination with core psychological processes, such as affect regulation and attachment, that have been implicated in the development and maintenance of severe mental health problems. METHODS/DESIGN One hundred participants meeting clinical high-risk criteria (CHR) for psychosis through the Comprehensive Assessment of At-Risk Mental State and Schizophrenia Proneness Instrument, Adult Version, in the age range from 16 to 35 years of age will be recruited. Mental-state monitoring up to a total of 2 years will be implemented to detect transition to psychosis. In addition, a sample of n = 40 help-seeking participants will be recruited who do not meet CHR-criteria, a group of n = 50 healthy control participants and a sample of n = 25 patients with first-episode psychosis. MEG-activity will be obtained during auditory and visual tasks to examine neural oscillations and event-related fields. In addition, we will obtain estimates of GABA and Glutamate levels through Magnetic Resonance Spectroscopy (MRS) to examine relationships between neural synchrony and excitatory-inhibition (E/I) balance parameters. Neuroimaging will be complemented by detailed neuropsychological assessments as well as psychological measures investigating the impact of childhood abuse, attachment experiences and affect regulation. DISCUSSION The YouR-study could potentially provide important insights into the neurobiological mechanisms that confer risk for psychosis as well as biomarkers for early diagnosis of severe mental health problems. Moreover, we expect novel data related to the contribution of affect regulation and attachment-processes in the development of mental health problems, leading to an integrative model of early stage psychosis and the factors underlying risk and resilience of emerging psychopathology.
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Affiliation(s)
- Peter J Uhlhaas
- Institute for Neuroscience and Psychology, University of Glasgow, 58 Hillhead Street, Glasgow, Scotland.
| | - Ruchika Gajwani
- Mental Health and Wellbeing, Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Joachim Gross
- Institute for Neuroscience and Psychology, University of Glasgow, 58 Hillhead Street, Glasgow, Scotland
| | - Andrew I Gumley
- Mental Health and Wellbeing, Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Stephen M Lawrie
- Department of Psychiatry, University of Edinburgh, Edinburgh, Scotland
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Flach C, French P, Dunn G, Fowler D, Gumley AI, Birchwood M, Stewart SLK, Morrison AP. Components of therapy as mechanisms of change in cognitive therapy for people at risk of psychosis: analysis of the EDIE-2 trial. Br J Psychiatry 2015; 207:123-9. [PMID: 25999337 DOI: 10.1192/bjp.bp.114.153320] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 11/06/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND Research suggests that the way in which cognitive therapy is delivered is an important factor in determining outcomes. We test the hypotheses in which the development of a shared problem list, use of case formulation, homework tasks and active intervention strategies will act as process variables. METHOD Presence of these components during therapy is taken from therapist notes. The direct and indirect effect of the intervention is estimated by an instrumental variable analysis. RESULTS A significant decrease in the symptom score for case formulation (coefficient = -23, 95% CI -44 to -1.7, P = 0.036) and homework (coefficient = -0.26, 95% CI -0.51 to -0.001, P = 0.049) is found. Improvement with the inclusion of active change strategies is of borderline significance (coefficient = -0.23, 95% CI -0.47 to 0.005, P = 0.056). CONCLUSIONS There is a greater treatment effect if formulation and homework are involved in therapy. However, high correlation between components means that these may be indicators of overall treatment fidelity.
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Affiliation(s)
- Clare Flach
- Clare Flach, PhD, Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester; Paul French, PhD, Psychosis Research Unit, Greater Manchester West NHS Foundation Trust, Manchester, and Department of Psychological Sciences, Liverpool University, Liverpool; Graham Dunn, PhD, Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester; David Fowler, MSc, School of Psychology, University of Sussex, Brighton; Andrew I. Gumley, PhD, Institute of Health and Wellbeing, University of Glasgow, Glasgow; Max Birchwood, DSc, Division of Mental Health and Wellbeing, University of Warwick, Warwick; Suzanne L. K. Stewart, PhD, Department of Psychology, University of Chester, Chester; Anthony P. Morrison, ClinPsyD, Psychosis Research Unit, Greater Manchester West NHS Foundation Trust, and School of Psychological Sciences, University of Manchester, Manchester, UK
| | - Paul French
- Clare Flach, PhD, Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester; Paul French, PhD, Psychosis Research Unit, Greater Manchester West NHS Foundation Trust, Manchester, and Department of Psychological Sciences, Liverpool University, Liverpool; Graham Dunn, PhD, Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester; David Fowler, MSc, School of Psychology, University of Sussex, Brighton; Andrew I. Gumley, PhD, Institute of Health and Wellbeing, University of Glasgow, Glasgow; Max Birchwood, DSc, Division of Mental Health and Wellbeing, University of Warwick, Warwick; Suzanne L. K. Stewart, PhD, Department of Psychology, University of Chester, Chester; Anthony P. Morrison, ClinPsyD, Psychosis Research Unit, Greater Manchester West NHS Foundation Trust, and School of Psychological Sciences, University of Manchester, Manchester, UK
| | - Graham Dunn
- Clare Flach, PhD, Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester; Paul French, PhD, Psychosis Research Unit, Greater Manchester West NHS Foundation Trust, Manchester, and Department of Psychological Sciences, Liverpool University, Liverpool; Graham Dunn, PhD, Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester; David Fowler, MSc, School of Psychology, University of Sussex, Brighton; Andrew I. Gumley, PhD, Institute of Health and Wellbeing, University of Glasgow, Glasgow; Max Birchwood, DSc, Division of Mental Health and Wellbeing, University of Warwick, Warwick; Suzanne L. K. Stewart, PhD, Department of Psychology, University of Chester, Chester; Anthony P. Morrison, ClinPsyD, Psychosis Research Unit, Greater Manchester West NHS Foundation Trust, and School of Psychological Sciences, University of Manchester, Manchester, UK
| | - David Fowler
- Clare Flach, PhD, Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester; Paul French, PhD, Psychosis Research Unit, Greater Manchester West NHS Foundation Trust, Manchester, and Department of Psychological Sciences, Liverpool University, Liverpool; Graham Dunn, PhD, Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester; David Fowler, MSc, School of Psychology, University of Sussex, Brighton; Andrew I. Gumley, PhD, Institute of Health and Wellbeing, University of Glasgow, Glasgow; Max Birchwood, DSc, Division of Mental Health and Wellbeing, University of Warwick, Warwick; Suzanne L. K. Stewart, PhD, Department of Psychology, University of Chester, Chester; Anthony P. Morrison, ClinPsyD, Psychosis Research Unit, Greater Manchester West NHS Foundation Trust, and School of Psychological Sciences, University of Manchester, Manchester, UK
| | - Andrew I Gumley
- Clare Flach, PhD, Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester; Paul French, PhD, Psychosis Research Unit, Greater Manchester West NHS Foundation Trust, Manchester, and Department of Psychological Sciences, Liverpool University, Liverpool; Graham Dunn, PhD, Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester; David Fowler, MSc, School of Psychology, University of Sussex, Brighton; Andrew I. Gumley, PhD, Institute of Health and Wellbeing, University of Glasgow, Glasgow; Max Birchwood, DSc, Division of Mental Health and Wellbeing, University of Warwick, Warwick; Suzanne L. K. Stewart, PhD, Department of Psychology, University of Chester, Chester; Anthony P. Morrison, ClinPsyD, Psychosis Research Unit, Greater Manchester West NHS Foundation Trust, and School of Psychological Sciences, University of Manchester, Manchester, UK
| | - Max Birchwood
- Clare Flach, PhD, Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester; Paul French, PhD, Psychosis Research Unit, Greater Manchester West NHS Foundation Trust, Manchester, and Department of Psychological Sciences, Liverpool University, Liverpool; Graham Dunn, PhD, Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester; David Fowler, MSc, School of Psychology, University of Sussex, Brighton; Andrew I. Gumley, PhD, Institute of Health and Wellbeing, University of Glasgow, Glasgow; Max Birchwood, DSc, Division of Mental Health and Wellbeing, University of Warwick, Warwick; Suzanne L. K. Stewart, PhD, Department of Psychology, University of Chester, Chester; Anthony P. Morrison, ClinPsyD, Psychosis Research Unit, Greater Manchester West NHS Foundation Trust, and School of Psychological Sciences, University of Manchester, Manchester, UK
| | - Suzanne L K Stewart
- Clare Flach, PhD, Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester; Paul French, PhD, Psychosis Research Unit, Greater Manchester West NHS Foundation Trust, Manchester, and Department of Psychological Sciences, Liverpool University, Liverpool; Graham Dunn, PhD, Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester; David Fowler, MSc, School of Psychology, University of Sussex, Brighton; Andrew I. Gumley, PhD, Institute of Health and Wellbeing, University of Glasgow, Glasgow; Max Birchwood, DSc, Division of Mental Health and Wellbeing, University of Warwick, Warwick; Suzanne L. K. Stewart, PhD, Department of Psychology, University of Chester, Chester; Anthony P. Morrison, ClinPsyD, Psychosis Research Unit, Greater Manchester West NHS Foundation Trust, and School of Psychological Sciences, University of Manchester, Manchester, UK
| | - Anthony P Morrison
- Clare Flach, PhD, Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester; Paul French, PhD, Psychosis Research Unit, Greater Manchester West NHS Foundation Trust, Manchester, and Department of Psychological Sciences, Liverpool University, Liverpool; Graham Dunn, PhD, Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester; David Fowler, MSc, School of Psychology, University of Sussex, Brighton; Andrew I. Gumley, PhD, Institute of Health and Wellbeing, University of Glasgow, Glasgow; Max Birchwood, DSc, Division of Mental Health and Wellbeing, University of Warwick, Warwick; Suzanne L. K. Stewart, PhD, Department of Psychology, University of Chester, Chester; Anthony P. Morrison, ClinPsyD, Psychosis Research Unit, Greater Manchester West NHS Foundation Trust, and School of Psychological Sciences, University of Manchester, Manchester, UK
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Morrison AP, Shryane N, Fowler D, Birchwood M, Gumley AI, Taylor HE, French P, Stewart SLK, Jones PB, Lewis SW, Bentall RP. Negative cognition, affect, metacognition and dimensions of paranoia in people at ultra-high risk of psychosis: a multi-level modelling analysis. Psychol Med 2015; 45:2675-2684. [PMID: 26165380 DOI: 10.1017/s0033291715000689] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Paranoia is one of the commonest symptoms of psychosis but has rarely been studied in a population at risk of developing psychosis. Based on existing theoretical models, including the proposed distinction between ‘poor me’ and ‘bad me’ paranoia, we aimed to test specific predictions about associations between negative cognition, metacognitive beliefs and negative emotions and paranoid ideation and the belief that persecution is deserved (deservedness). METHOD We used data from 117 participants from the Early Detection and Intervention Evaluation for people at risk of psychosis (EDIE-2) trial of cognitive–behaviour therapy, comparing them with samples of psychiatric in-patients and healthy students from a previous study. Multi-level modelling was utilized to examine predictors of both paranoia and deservedness, with post-hoc planned comparisons conducted to test whether person-level predictor variables were associated differentially with paranoia or with deservedness. RESULTS Our sample of at-risk mental state participants was not as paranoid, but reported higher levels of ‘bad-me’ deservedness, compared with psychiatric in-patients. We found several predictors of paranoia and deservedness. Negative beliefs about self were related to deservedness but not paranoia, whereas negative beliefs about others were positively related to paranoia but negatively with deservedness. Both depression and negative metacognitive beliefs about paranoid thinking were specifically related to paranoia but not deservedness. CONCLUSIONS This study provides evidence for the role of negative cognition, metacognition and negative affect in the development of paranoid beliefs, which has implications for psychological interventions and our understanding of psychosis.
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White RG, Lysaker P, Gumley AI, McLeod H, McCleery M, O'Neill D, MacBeth A, Giurgi-Oncu C, Mulholland CC. Plasma cortisol levels and illness appraisal in deficit syndrome schizophrenia. Psychiatry Res 2014; 220:765-71. [PMID: 25262562 DOI: 10.1016/j.psychres.2014.08.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 08/21/2014] [Accepted: 08/24/2014] [Indexed: 12/01/2022]
Abstract
Research investigating the association between negative symptoms and plasma cortisol levels in individuals with schizophrenia has produced inconsistent findings. This study investigated whether deficit syndrome schizophrenia (characterized by high levels of primary negative symptoms) is associated with comparatively high morning plasma cortisol levels, more negative appraisals about illness and higher levels of depression. Participants were 85 individuals diagnosed with schizophrenia and 85 individuals with no history of contact with psychiatric services matched for age and gender. All participants provided fasting 9.00a.m. plasma cortisol samples. There were no significant differences between the schizophrenia and control participants in plasma cortisol levels. The Proximal Deficit Syndrome method was used to identify individuals with deficit syndrome schizophrenia. Contrary to what had been hypothesized, participants with deficit syndrome schizophrenia had significantly lower plasma cortisol levels than both non-deficit syndrome participants and control participants. Participants with the deficit syndrome reported significantly less negative appraisals about illness (assessed by PBIQ) and lower levels of depression (assessed by BDI-II). Differences in cortisol levels continued to trend toward significance when levels of depression were controlled for. The patterns of illness-related appraisals and plasma cortisol levels raise the possibility that the deficit syndrome could be a form of adaptation syndrome.
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Affiliation(s)
- Ross G White
- Institute of Health and Well-being, The University of Glasgow, Glasgow G12 0XH, UK.
| | - Paul Lysaker
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN 46202, USA; Department of Psychiatry, Roudebush VA Medical Center, Indianapolis, IN, USA
| | - Andrew I Gumley
- Institute of Health and Well-being, The University of Glasgow, Glasgow G12 0XH, UK
| | - Hamish McLeod
- Institute of Health and Well-being, The University of Glasgow, Glasgow G12 0XH, UK
| | - Muriel McCleery
- Department of Psychiatry, The Queen's University of Belfast, Belfast BT7 1NN, Ireland
| | - Donnacha O'Neill
- Department of Psychiatry, The Queen's University of Belfast, Belfast BT7 1NN, Ireland
| | - Angus MacBeth
- Centre for Rural Health, University of Aberdeen, Aberdeen AB24 3FX, UK
| | - Catalina Giurgi-Oncu
- The Victor Babeș University of Medicine and Pharmacy of Timișoara, 300041, Romania
| | - Ciaran C Mulholland
- Department of Psychiatry, The Queen's University of Belfast, Belfast BT7 1NN, Ireland
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Gumley AI, MacBeth A, Reilly JD, O'Grady M, White RG, McLeod H, Schwannauer M, Power KG. Fear of recurrence: results of a randomized trial of relapse detection in schizophrenia. Br J Clin Psychol 2014; 54:49-62. [PMID: 25040487 DOI: 10.1111/bjc.12060] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Revised: 06/10/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We aimed to develop and establish the reliability and validity of a measure of Fear of Recurrence, measuring cognitive appraisals of relapse rather than standard early signs of relapse. We also aimed to establish the sensitivity and specificity to relapse. METHOD Participants diagnosed with schizophrenia or a related disorder were randomized to one of two early signs monitoring conditions, using either the Early Signs Scale or the Fear of Recurrence Scale (FoRSe). Participants were followed up for 6-months or until relapse. RESULTS A total of 169 participants were randomized to Standard (n = 86) or FoRSe (n = 83) monitoring. We found good evidence supporting reliability and validity of the FoRSe. In addition, a cut-off point of ≥ 5 was associated with an optimal sensitivity in both Standard (n = 26:79%, 95% CI = 62-89) and FoRSe (n = 18:72%, 95% CI = 52-86) monitoring. However, this degree of sensitivity was associated with a lower specificity in Standard (n = 30:35%, 96% CI = 23-50) and FoRSe (n = 25:46%, 95% CI = 32-60). Finally, Fear of Relapse was a significant predictor of time to relapse [Exp(β) = 1.20, 95% CI = 1.01-1.42, p < .05]. CONCLUSION The study provides evidence that Fear of Recurrence may be an important clinical construct linked to increased risk of relapse and poorer emotional recovery in people diagnosed with schizophrenia. PRACTITIONER POINTS Monitoring Fear of Recurrence is as sensitive to relapse detection as monitoring early signs alone. Greater Fear of Relapse was associated with shorter duration to actual relapse. Fear of recurrence may be an important clinical feature linked to poorer emotional recovery and increased risk of relapse. Fear of Recurrence may be an important focus of psychological therapy to promote emotional recovery and prevention of relapse.
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Affiliation(s)
- Andrew I Gumley
- Institute of Health and Wellbeing, University of Glasgow, UK
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28
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McLeod HJ, Gumley AI, Macbeth A, Schwannauer M, Lysaker PH. Metacognitive functioning predicts positive and negative symptoms over 12 months in first episode psychosis. J Psychiatr Res 2014; 54:109-15. [PMID: 24725651 DOI: 10.1016/j.jpsychires.2014.03.018] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 03/12/2014] [Accepted: 03/19/2014] [Indexed: 12/24/2022]
Abstract
The negative symptoms of schizophrenia are a major source of impairment and distress but both pharmacological and psychological treatment options provide only modest benefit. Developing more effective psychological treatments for negative symptoms will require a more sophisticated understanding of the psychological processes that are implicated in their development and maintenance. We extended previous work by demonstrating that metacognitive functioning is related to negative symptom expression across the first 12 months of first episode psychosis (FEP). Previous studies in this area have either been cross-sectional or have used much older participants with long-standing symptoms. In this study, forty-five FEP participants were assessed three times over 12 months and provided data on PANSS rated symptoms, premorbid adjustment, metacognitive functioning, and DUP. Step-wise linear regression showed that adding metacognition scores to known predictors of negative symptoms (baseline symptom severity, gender, DUP, and premorbid academic and social adjustment) accounted for 62% of the variance in PANSS negative symptom scores at six months and 38% at 12 months. The same predictors also explained 47% of the variance in positive symptoms at both six and 12 months. However, exploration of the simple correlations between PANSS symptom scores and metacognition suggests a stronger univariate relationship between metacognition and negative symptoms. Overall, the results indicate that problems with mental state processing may be important determinants of negative symptom expression from the very early stages of psychosis. These results provide further evidence that metacognitive functioning is a potentially relevant target for psychological interventions.
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Affiliation(s)
- Hamish J McLeod
- Institute of Health and Wellbeing, University of Glasgow, Academic Centre, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow G12 0XH, UK.
| | - Andrew I Gumley
- Institute of Health and Wellbeing, University of Glasgow, Academic Centre, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow G12 0XH, UK.
| | - Angus Macbeth
- NHS Grampian, Psychiatry Research Group, Clinical Research Centre, Royal Cornhill Hospital, Aberdeen AB25 2ZD, UK; University of Aberdeen, Psychiatry Research Group, Clinical Research Centre, Royal Cornhill Hospital, Aberdeen AB25 2ZD, UK.
| | - Matthias Schwannauer
- Section of Clinical & Health Psychology, University of Edinburgh Medical School, Teviot Place, Edinburgh EH8 9AG, UK.
| | - Paul H Lysaker
- Roudebush VA Medical Center, Indiana University School of Medicine, USA; Department of Psychiatry, Indiana University School of Medicine, USA.
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Gumley AI, Schwannauer M, Macbeth A, Fisher R, Clark S, Rattrie L, Fraser G, McCabe R, Blair A, Davidson K, Birchwood M. Insight, duration of untreated psychosis and attachment in first-episode psychosis: prospective study of psychiatric recovery over 12-month follow-up. Br J Psychiatry 2014; 205:60-7. [PMID: 24723630 DOI: 10.1192/bjp.bp.113.126722] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Increasing evidence shows attachment security influences symptom expression and adaptation in people diagnosed with schizophrenia and other psychoses. AIMS To describe the distribution of secure and insecure attachment in a cohort of individuals with first-episode psychosis, and to explore the relationship between attachment security and recovery from positive and negative symptoms in the first 12 months. METHOD The study was a prospective 12-month cohort study. The role of attachment, duration of untreated psychosis (DUP), baseline symptoms and insight in predicting and mediating recovery from symptoms was investigated using multiple regression analysis and path analysis. RESULTS Of the 79 participants, 54 completed the Adult Attachment Interview (AAI): 37 (68.5%) were classified as insecure, of which 26 (48.1%) were insecure/dismissing and 11 (20.4%) insecure preoccupied. Both DUP and insight predicted recovery from positive symptoms at 12 months. Attachment security, DUP and insight predicted recovery from negative symptoms at 12 months. CONCLUSIONS Attachment is an important construct contributing to understanding and development of interventions promoting recovery following first-episode psychosis.
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Affiliation(s)
- A I Gumley
- A. I. Gumley, BA(Hons), MAppSci, PhD, AFBPsS, CPsychol, Institute of Health and Wellbeing, University of Glasgow, and ESTEEM First Episode Psychosis Service, NHS Greater Glasgow and Clyde, Glasgow; M. Schwannauer, MA, DPsych, PhD, Department of Clinical & Health Psychology, University of Edinburgh, Edinburgh, and Early Psychosis Support Service, NHS Lothian, Edinburgh; A. Macbeth, DClinPsy, PhD, Institute of Health and Wellbeing, University of Glasgow, Glasgow, and Institute of Medical Sciences, University of Aberdeen, Aberdeen; R. Fisher, PhD, Early Psychosis Support Service, NHS Lothian, Edinburgh, and Department of Clinical & Health Psychology, University of Edinburgh, Edinburgh; S. Clark, MA(Hons), DClinPsychol, ESTEEM First Episode Psychosis Service, NHS Greater Glasgow and Clyde, Glasgow; L. Rattrie, BSc(Hons), MSc, PhD, Institute of Health and Wellbeing, University of Glasgow, Glasgow; G. Fraser, MSc, Early Psychosis Support Service, NHS Lothian, Edinburgh; R. McCabe, MBChB, MPhil, FRCPsych, Early Psychosis Support Service, NHS Lothian, Edinburgh; A. Blair, FRCPsych, ESTEEM First Episode Psychosis Service, NHS Greater Glasgow and Clyde, Glasgow; K. Davidson, MA, MPhil, PhD, FBPsS, CPsychol, Institute of Health and Wellbeing University of Glasgow, and Glasgow Institute for Psychosocial Interventions, NHS Greater Glasgow and Clyde, Glasgow; M. Birchwood, BSc, PhD, DSc, FBPsS, Warwick Medical School, University of Warwick, Warwick, UK
| | - M Schwannauer
- A. I. Gumley, BA(Hons), MAppSci, PhD, AFBPsS, CPsychol, Institute of Health and Wellbeing, University of Glasgow, and ESTEEM First Episode Psychosis Service, NHS Greater Glasgow and Clyde, Glasgow; M. Schwannauer, MA, DPsych, PhD, Department of Clinical & Health Psychology, University of Edinburgh, Edinburgh, and Early Psychosis Support Service, NHS Lothian, Edinburgh; A. Macbeth, DClinPsy, PhD, Institute of Health and Wellbeing, University of Glasgow, Glasgow, and Institute of Medical Sciences, University of Aberdeen, Aberdeen; R. Fisher, PhD, Early Psychosis Support Service, NHS Lothian, Edinburgh, and Department of Clinical & Health Psychology, University of Edinburgh, Edinburgh; S. Clark, MA(Hons), DClinPsychol, ESTEEM First Episode Psychosis Service, NHS Greater Glasgow and Clyde, Glasgow; L. Rattrie, BSc(Hons), MSc, PhD, Institute of Health and Wellbeing, University of Glasgow, Glasgow; G. Fraser, MSc, Early Psychosis Support Service, NHS Lothian, Edinburgh; R. McCabe, MBChB, MPhil, FRCPsych, Early Psychosis Support Service, NHS Lothian, Edinburgh; A. Blair, FRCPsych, ESTEEM First Episode Psychosis Service, NHS Greater Glasgow and Clyde, Glasgow; K. Davidson, MA, MPhil, PhD, FBPsS, CPsychol, Institute of Health and Wellbeing University of Glasgow, and Glasgow Institute for Psychosocial Interventions, NHS Greater Glasgow and Clyde, Glasgow; M. Birchwood, BSc, PhD, DSc, FBPsS, Warwick Medical School, University of Warwick, Warwick, UK
| | - A Macbeth
- A. I. Gumley, BA(Hons), MAppSci, PhD, AFBPsS, CPsychol, Institute of Health and Wellbeing, University of Glasgow, and ESTEEM First Episode Psychosis Service, NHS Greater Glasgow and Clyde, Glasgow; M. Schwannauer, MA, DPsych, PhD, Department of Clinical & Health Psychology, University of Edinburgh, Edinburgh, and Early Psychosis Support Service, NHS Lothian, Edinburgh; A. Macbeth, DClinPsy, PhD, Institute of Health and Wellbeing, University of Glasgow, Glasgow, and Institute of Medical Sciences, University of Aberdeen, Aberdeen; R. Fisher, PhD, Early Psychosis Support Service, NHS Lothian, Edinburgh, and Department of Clinical & Health Psychology, University of Edinburgh, Edinburgh; S. Clark, MA(Hons), DClinPsychol, ESTEEM First Episode Psychosis Service, NHS Greater Glasgow and Clyde, Glasgow; L. Rattrie, BSc(Hons), MSc, PhD, Institute of Health and Wellbeing, University of Glasgow, Glasgow; G. Fraser, MSc, Early Psychosis Support Service, NHS Lothian, Edinburgh; R. McCabe, MBChB, MPhil, FRCPsych, Early Psychosis Support Service, NHS Lothian, Edinburgh; A. Blair, FRCPsych, ESTEEM First Episode Psychosis Service, NHS Greater Glasgow and Clyde, Glasgow; K. Davidson, MA, MPhil, PhD, FBPsS, CPsychol, Institute of Health and Wellbeing University of Glasgow, and Glasgow Institute for Psychosocial Interventions, NHS Greater Glasgow and Clyde, Glasgow; M. Birchwood, BSc, PhD, DSc, FBPsS, Warwick Medical School, University of Warwick, Warwick, UK
| | - R Fisher
- A. I. Gumley, BA(Hons), MAppSci, PhD, AFBPsS, CPsychol, Institute of Health and Wellbeing, University of Glasgow, and ESTEEM First Episode Psychosis Service, NHS Greater Glasgow and Clyde, Glasgow; M. Schwannauer, MA, DPsych, PhD, Department of Clinical & Health Psychology, University of Edinburgh, Edinburgh, and Early Psychosis Support Service, NHS Lothian, Edinburgh; A. Macbeth, DClinPsy, PhD, Institute of Health and Wellbeing, University of Glasgow, Glasgow, and Institute of Medical Sciences, University of Aberdeen, Aberdeen; R. Fisher, PhD, Early Psychosis Support Service, NHS Lothian, Edinburgh, and Department of Clinical & Health Psychology, University of Edinburgh, Edinburgh; S. Clark, MA(Hons), DClinPsychol, ESTEEM First Episode Psychosis Service, NHS Greater Glasgow and Clyde, Glasgow; L. Rattrie, BSc(Hons), MSc, PhD, Institute of Health and Wellbeing, University of Glasgow, Glasgow; G. Fraser, MSc, Early Psychosis Support Service, NHS Lothian, Edinburgh; R. McCabe, MBChB, MPhil, FRCPsych, Early Psychosis Support Service, NHS Lothian, Edinburgh; A. Blair, FRCPsych, ESTEEM First Episode Psychosis Service, NHS Greater Glasgow and Clyde, Glasgow; K. Davidson, MA, MPhil, PhD, FBPsS, CPsychol, Institute of Health and Wellbeing University of Glasgow, and Glasgow Institute for Psychosocial Interventions, NHS Greater Glasgow and Clyde, Glasgow; M. Birchwood, BSc, PhD, DSc, FBPsS, Warwick Medical School, University of Warwick, Warwick, UK
| | - S Clark
- A. I. Gumley, BA(Hons), MAppSci, PhD, AFBPsS, CPsychol, Institute of Health and Wellbeing, University of Glasgow, and ESTEEM First Episode Psychosis Service, NHS Greater Glasgow and Clyde, Glasgow; M. Schwannauer, MA, DPsych, PhD, Department of Clinical & Health Psychology, University of Edinburgh, Edinburgh, and Early Psychosis Support Service, NHS Lothian, Edinburgh; A. Macbeth, DClinPsy, PhD, Institute of Health and Wellbeing, University of Glasgow, Glasgow, and Institute of Medical Sciences, University of Aberdeen, Aberdeen; R. Fisher, PhD, Early Psychosis Support Service, NHS Lothian, Edinburgh, and Department of Clinical & Health Psychology, University of Edinburgh, Edinburgh; S. Clark, MA(Hons), DClinPsychol, ESTEEM First Episode Psychosis Service, NHS Greater Glasgow and Clyde, Glasgow; L. Rattrie, BSc(Hons), MSc, PhD, Institute of Health and Wellbeing, University of Glasgow, Glasgow; G. Fraser, MSc, Early Psychosis Support Service, NHS Lothian, Edinburgh; R. McCabe, MBChB, MPhil, FRCPsych, Early Psychosis Support Service, NHS Lothian, Edinburgh; A. Blair, FRCPsych, ESTEEM First Episode Psychosis Service, NHS Greater Glasgow and Clyde, Glasgow; K. Davidson, MA, MPhil, PhD, FBPsS, CPsychol, Institute of Health and Wellbeing University of Glasgow, and Glasgow Institute for Psychosocial Interventions, NHS Greater Glasgow and Clyde, Glasgow; M. Birchwood, BSc, PhD, DSc, FBPsS, Warwick Medical School, University of Warwick, Warwick, UK
| | - L Rattrie
- A. I. Gumley, BA(Hons), MAppSci, PhD, AFBPsS, CPsychol, Institute of Health and Wellbeing, University of Glasgow, and ESTEEM First Episode Psychosis Service, NHS Greater Glasgow and Clyde, Glasgow; M. Schwannauer, MA, DPsych, PhD, Department of Clinical & Health Psychology, University of Edinburgh, Edinburgh, and Early Psychosis Support Service, NHS Lothian, Edinburgh; A. Macbeth, DClinPsy, PhD, Institute of Health and Wellbeing, University of Glasgow, Glasgow, and Institute of Medical Sciences, University of Aberdeen, Aberdeen; R. Fisher, PhD, Early Psychosis Support Service, NHS Lothian, Edinburgh, and Department of Clinical & Health Psychology, University of Edinburgh, Edinburgh; S. Clark, MA(Hons), DClinPsychol, ESTEEM First Episode Psychosis Service, NHS Greater Glasgow and Clyde, Glasgow; L. Rattrie, BSc(Hons), MSc, PhD, Institute of Health and Wellbeing, University of Glasgow, Glasgow; G. Fraser, MSc, Early Psychosis Support Service, NHS Lothian, Edinburgh; R. McCabe, MBChB, MPhil, FRCPsych, Early Psychosis Support Service, NHS Lothian, Edinburgh; A. Blair, FRCPsych, ESTEEM First Episode Psychosis Service, NHS Greater Glasgow and Clyde, Glasgow; K. Davidson, MA, MPhil, PhD, FBPsS, CPsychol, Institute of Health and Wellbeing University of Glasgow, and Glasgow Institute for Psychosocial Interventions, NHS Greater Glasgow and Clyde, Glasgow; M. Birchwood, BSc, PhD, DSc, FBPsS, Warwick Medical School, University of Warwick, Warwick, UK
| | - G Fraser
- A. I. Gumley, BA(Hons), MAppSci, PhD, AFBPsS, CPsychol, Institute of Health and Wellbeing, University of Glasgow, and ESTEEM First Episode Psychosis Service, NHS Greater Glasgow and Clyde, Glasgow; M. Schwannauer, MA, DPsych, PhD, Department of Clinical & Health Psychology, University of Edinburgh, Edinburgh, and Early Psychosis Support Service, NHS Lothian, Edinburgh; A. Macbeth, DClinPsy, PhD, Institute of Health and Wellbeing, University of Glasgow, Glasgow, and Institute of Medical Sciences, University of Aberdeen, Aberdeen; R. Fisher, PhD, Early Psychosis Support Service, NHS Lothian, Edinburgh, and Department of Clinical & Health Psychology, University of Edinburgh, Edinburgh; S. Clark, MA(Hons), DClinPsychol, ESTEEM First Episode Psychosis Service, NHS Greater Glasgow and Clyde, Glasgow; L. Rattrie, BSc(Hons), MSc, PhD, Institute of Health and Wellbeing, University of Glasgow, Glasgow; G. Fraser, MSc, Early Psychosis Support Service, NHS Lothian, Edinburgh; R. McCabe, MBChB, MPhil, FRCPsych, Early Psychosis Support Service, NHS Lothian, Edinburgh; A. Blair, FRCPsych, ESTEEM First Episode Psychosis Service, NHS Greater Glasgow and Clyde, Glasgow; K. Davidson, MA, MPhil, PhD, FBPsS, CPsychol, Institute of Health and Wellbeing University of Glasgow, and Glasgow Institute for Psychosocial Interventions, NHS Greater Glasgow and Clyde, Glasgow; M. Birchwood, BSc, PhD, DSc, FBPsS, Warwick Medical School, University of Warwick, Warwick, UK
| | - R McCabe
- A. I. Gumley, BA(Hons), MAppSci, PhD, AFBPsS, CPsychol, Institute of Health and Wellbeing, University of Glasgow, and ESTEEM First Episode Psychosis Service, NHS Greater Glasgow and Clyde, Glasgow; M. Schwannauer, MA, DPsych, PhD, Department of Clinical & Health Psychology, University of Edinburgh, Edinburgh, and Early Psychosis Support Service, NHS Lothian, Edinburgh; A. Macbeth, DClinPsy, PhD, Institute of Health and Wellbeing, University of Glasgow, Glasgow, and Institute of Medical Sciences, University of Aberdeen, Aberdeen; R. Fisher, PhD, Early Psychosis Support Service, NHS Lothian, Edinburgh, and Department of Clinical & Health Psychology, University of Edinburgh, Edinburgh; S. Clark, MA(Hons), DClinPsychol, ESTEEM First Episode Psychosis Service, NHS Greater Glasgow and Clyde, Glasgow; L. Rattrie, BSc(Hons), MSc, PhD, Institute of Health and Wellbeing, University of Glasgow, Glasgow; G. Fraser, MSc, Early Psychosis Support Service, NHS Lothian, Edinburgh; R. McCabe, MBChB, MPhil, FRCPsych, Early Psychosis Support Service, NHS Lothian, Edinburgh; A. Blair, FRCPsych, ESTEEM First Episode Psychosis Service, NHS Greater Glasgow and Clyde, Glasgow; K. Davidson, MA, MPhil, PhD, FBPsS, CPsychol, Institute of Health and Wellbeing University of Glasgow, and Glasgow Institute for Psychosocial Interventions, NHS Greater Glasgow and Clyde, Glasgow; M. Birchwood, BSc, PhD, DSc, FBPsS, Warwick Medical School, University of Warwick, Warwick, UK
| | - A Blair
- A. I. Gumley, BA(Hons), MAppSci, PhD, AFBPsS, CPsychol, Institute of Health and Wellbeing, University of Glasgow, and ESTEEM First Episode Psychosis Service, NHS Greater Glasgow and Clyde, Glasgow; M. Schwannauer, MA, DPsych, PhD, Department of Clinical & Health Psychology, University of Edinburgh, Edinburgh, and Early Psychosis Support Service, NHS Lothian, Edinburgh; A. Macbeth, DClinPsy, PhD, Institute of Health and Wellbeing, University of Glasgow, Glasgow, and Institute of Medical Sciences, University of Aberdeen, Aberdeen; R. Fisher, PhD, Early Psychosis Support Service, NHS Lothian, Edinburgh, and Department of Clinical & Health Psychology, University of Edinburgh, Edinburgh; S. Clark, MA(Hons), DClinPsychol, ESTEEM First Episode Psychosis Service, NHS Greater Glasgow and Clyde, Glasgow; L. Rattrie, BSc(Hons), MSc, PhD, Institute of Health and Wellbeing, University of Glasgow, Glasgow; G. Fraser, MSc, Early Psychosis Support Service, NHS Lothian, Edinburgh; R. McCabe, MBChB, MPhil, FRCPsych, Early Psychosis Support Service, NHS Lothian, Edinburgh; A. Blair, FRCPsych, ESTEEM First Episode Psychosis Service, NHS Greater Glasgow and Clyde, Glasgow; K. Davidson, MA, MPhil, PhD, FBPsS, CPsychol, Institute of Health and Wellbeing University of Glasgow, and Glasgow Institute for Psychosocial Interventions, NHS Greater Glasgow and Clyde, Glasgow; M. Birchwood, BSc, PhD, DSc, FBPsS, Warwick Medical School, University of Warwick, Warwick, UK
| | - K Davidson
- A. I. Gumley, BA(Hons), MAppSci, PhD, AFBPsS, CPsychol, Institute of Health and Wellbeing, University of Glasgow, and ESTEEM First Episode Psychosis Service, NHS Greater Glasgow and Clyde, Glasgow; M. Schwannauer, MA, DPsych, PhD, Department of Clinical & Health Psychology, University of Edinburgh, Edinburgh, and Early Psychosis Support Service, NHS Lothian, Edinburgh; A. Macbeth, DClinPsy, PhD, Institute of Health and Wellbeing, University of Glasgow, Glasgow, and Institute of Medical Sciences, University of Aberdeen, Aberdeen; R. Fisher, PhD, Early Psychosis Support Service, NHS Lothian, Edinburgh, and Department of Clinical & Health Psychology, University of Edinburgh, Edinburgh; S. Clark, MA(Hons), DClinPsychol, ESTEEM First Episode Psychosis Service, NHS Greater Glasgow and Clyde, Glasgow; L. Rattrie, BSc(Hons), MSc, PhD, Institute of Health and Wellbeing, University of Glasgow, Glasgow; G. Fraser, MSc, Early Psychosis Support Service, NHS Lothian, Edinburgh; R. McCabe, MBChB, MPhil, FRCPsych, Early Psychosis Support Service, NHS Lothian, Edinburgh; A. Blair, FRCPsych, ESTEEM First Episode Psychosis Service, NHS Greater Glasgow and Clyde, Glasgow; K. Davidson, MA, MPhil, PhD, FBPsS, CPsychol, Institute of Health and Wellbeing University of Glasgow, and Glasgow Institute for Psychosocial Interventions, NHS Greater Glasgow and Clyde, Glasgow; M. Birchwood, BSc, PhD, DSc, FBPsS, Warwick Medical School, University of Warwick, Warwick, UK
| | - M Birchwood
- A. I. Gumley, BA(Hons), MAppSci, PhD, AFBPsS, CPsychol, Institute of Health and Wellbeing, University of Glasgow, and ESTEEM First Episode Psychosis Service, NHS Greater Glasgow and Clyde, Glasgow; M. Schwannauer, MA, DPsych, PhD, Department of Clinical & Health Psychology, University of Edinburgh, Edinburgh, and Early Psychosis Support Service, NHS Lothian, Edinburgh; A. Macbeth, DClinPsy, PhD, Institute of Health and Wellbeing, University of Glasgow, Glasgow, and Institute of Medical Sciences, University of Aberdeen, Aberdeen; R. Fisher, PhD, Early Psychosis Support Service, NHS Lothian, Edinburgh, and Department of Clinical & Health Psychology, University of Edinburgh, Edinburgh; S. Clark, MA(Hons), DClinPsychol, ESTEEM First Episode Psychosis Service, NHS Greater Glasgow and Clyde, Glasgow; L. Rattrie, BSc(Hons), MSc, PhD, Institute of Health and Wellbeing, University of Glasgow, Glasgow; G. Fraser, MSc, Early Psychosis Support Service, NHS Lothian, Edinburgh; R. McCabe, MBChB, MPhil, FRCPsych, Early Psychosis Support Service, NHS Lothian, Edinburgh; A. Blair, FRCPsych, ESTEEM First Episode Psychosis Service, NHS Greater Glasgow and Clyde, Glasgow; K. Davidson, MA, MPhil, PhD, FBPsS, CPsychol, Institute of Health and Wellbeing University of Glasgow, and Glasgow Institute for Psychosocial Interventions, NHS Greater Glasgow and Clyde, Glasgow; M. Birchwood, BSc, PhD, DSc, FBPsS, Warwick Medical School, University of Warwick, Warwick, UK
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Gumley AI, Taylor HEF, Schwannauer M, MacBeth A. A systematic review of attachment and psychosis: measurement, construct validity and outcomes. Acta Psychiatr Scand 2014; 129:257-74. [PMID: 23834647 DOI: 10.1111/acps.12172] [Citation(s) in RCA: 130] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/03/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This review sought to identify, summarise and critically evaluate studies that investigated attachment amongst individuals with psychosis. METHOD The following computerised databases searched were CINAHL<1980 to December 2012; EMBASE<1980 to December 2012; Ovid MEDLINE (R)<1980 to December 2012; PsychINFO<1980 to December 2012; and Google Scholar<1980 to December 2012. RESULTS We identified 22 papers describing 21 studies comprising 1453 participants, with a mean age of 35.0 years (range of 12-71 years), of whom 68.4% (n=994) were male. Of our sample, 1112 (76.5%) had a diagnosis of schizophrenia. We found small to moderate associations between greater attachment insecurity (as reflected in anxiety and avoidance) and poorer engagement with services, more interpersonal problems, more avoidant coping strategies, more negative appraisals of parenting experiences and more severe trauma. We also found small to modest associations between attachment insecurity and more positive and negative symptoms and greater affective symptom problems. CONCLUSION Attachment theory may be useful as a means of understanding the developmental and interpersonal basis of recovery and adaptation in the context of psychosis. However, further research comprising more representative samples in their first episode and using prospective designs is required.
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Affiliation(s)
- A I Gumley
- University of Glasgow, Glasgow, UK; NHS Greater Glasgow & Clyde, Glasgow, UK
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Morrison AP, Birchwood M, Pyle M, Flach C, Stewart SLK, Byrne R, Patterson P, Jones PB, Fowler D, Gumley AI, French P. Impact of cognitive therapy on internalised stigma in people with at-risk mental states. Br J Psychiatry 2013; 203:140-5. [PMID: 23846995 DOI: 10.1192/bjp.bp.112.123703] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Internalised stigma in young people meeting criteria for at-risk mental states (ARMS) has been highlighted as an important issue, and it has been suggested that provision of cognitive therapy may increase such stigma. AIMS To investigate the effects of cognitive therapy on internalised stigma using a secondary analysis of data from the EDIE-2 trial. METHOD Participants meeting criteria for ARMS were recruited as part of a multisite randomised controlled trial of cognitive therapy for prevention and amelioration of psychosis. Participants were assessed at baseline and at 6, 12, 18 and 24 months using measures of psychotic experiences, symptoms and internalised stigma. RESULTS Negative appraisals of experiences were significantly reduced in the group assigned to cognitive therapy (estimated difference at 12 months was -1.36 (95% CI -2.69 to -0.02), P = 0.047). There was no difference in social acceptability of experiences (estimated difference at 12 months was 0.46, 95% CI -0.05 to 0.98, P = 0.079). CONCLUSIONS These findings suggest that, rather than increasing internalised stigma, cognitive therapy decreases negative appraisals of unusual experiences in young people at risk of psychosis; as such, it is a non-stigmatising intervention for this population.
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Affiliation(s)
- Anthony P Morrison
- School of Psychological Sciences, University of Manchester and Greater Manchester West Mental Health NHS Foundation Trust, Manchester, UK.
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Morrison AP, French P, Stewart SLK, Birchwood M, Fowler D, Gumley AI, Jones PB, Bentall RP, Lewis SW, Murray GK, Patterson P, Brunet K, Conroy J, Parker S, Reilly T, Byrne R, Davies LM, Dunn G. Early detection and intervention evaluation for people at risk of psychosis: multisite randomised controlled trial. BMJ 2012; 344:e2233. [PMID: 22491790 PMCID: PMC3320714 DOI: 10.1136/bmj.e2233] [Citation(s) in RCA: 224] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
OBJECTIVE To determine whether cognitive therapy is effective in preventing the worsening of emerging psychotic symptoms experienced by help seeking young people deemed to be at risk for serious conditions such as schizophrenia. DESIGN Multisite single blind randomised controlled trial. SETTING Diverse services at five UK sites. PARTICIPANTS 288 participants aged 14-35 years (mean 20.74, SD 4.34 years) at high risk of psychosis: 144 were assigned to cognitive therapy plus monitoring of mental state and 144 to monitoring of mental state only. Participants were followed-up for a minimum of 12 months and a maximum of 24 months. INTERVENTION Cognitive therapy (up to 26 (mean 9.1) sessions over six months) plus monitoring of mental state compared with monitoring of mental state only. MAIN OUTCOME MEASURES Primary outcome was scores on the comprehensive assessment of at risk mental states (CAARMS), which provides a dichotomous transition to psychosis score and ordinal scores for severity of psychotic symptoms and distress. Secondary outcomes included emotional dysfunction and quality of life. RESULTS Transition to psychosis based on intention to treat was analysed using discrete time survival models. Overall, the prevalence of transition was lower than expected (23/288; 8%), with no significant difference between the two groups (proportional odds ratio 0.73, 95% confidence interval 0.32 to 1.68). Changes in severity of symptoms and distress, as well as secondary outcomes, were analysed using random effects regression (analysis of covariance) adjusted for site and baseline symptoms. Distress from psychotic symptoms did not differ (estimated difference at 12 months -3.00, 95% confidence interval -6.95 to 0.94) but their severity was significantly reduced in the group assigned to cognitive therapy (estimated between group effect size at 12 months -3.67, -6.71 to -0.64, P=0.018). CONCLUSIONS Cognitive therapy plus monitoring did not significantly reduce transition to psychosis or symptom related distress but reduced the severity of psychotic symptoms in young people at high risk. Most participants in both groups improved over time. The results have important implications for the at risk mental state concept. TRIAL REGISTRATION Current Controlled Trials ISRCTN56283883.
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Affiliation(s)
- Anthony P Morrison
- School of Psychological Sciences, University of Manchester, Manchester M13 9PL, UK.
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Morrison AP, Gumley AI, Ashcroft K, Manousos IR, White R, Gillan K, Wells A, Kingdon D. Metacognition and persecutory delusions: Tests of a metacognitive model in a clinical population and comparisons with non-patients. British Journal of Clinical Psychology 2011; 50:223-33. [DOI: 10.1348/014466510x511141] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Morrison AP, Stewart SLK, French P, Bentall RP, Birchwood M, Byrne R, Davies LM, Fowler D, Gumley AI, Jones PB, Lewis SW, Murray GK, Patterson P, Dunn G. Early detection and intervention evaluation for people at high-risk of psychosis-2 (EDIE-2): trial rationale, design and baseline characteristics. Early Interv Psychiatry 2011; 5:24-32. [PMID: 21272272 DOI: 10.1111/j.1751-7893.2010.00254.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
AIMS Much research has begun to focus on the identification of people who are at high risk of developing psychosis, and clinical services have been initiated for this population. However, only a small number of studies have reported on the efficacy of interventions for preventing or delaying the onset of psychosis. The results of prior work suggest that cognitive therapy (CT) may be an effective, well-tolerated treatment. We report on the rationale and design for a large-scale, multi-site randomized, controlled trial of CT for people who are assessed to be at high risk of psychosis because of either state or state-plus-trait risk factors. METHODS The study employs a single-blind design in which all participants receive frequent mental-state monitoring, which will efficiently detect transition to psychosis, and half are randomized to weekly sessions of CT for up to 6 months. Participants will be followed-up for a minimum of 12 months and to a maximum of 2 years. RESULTS We report the characteristics of the final sample at baseline (n=288). CONCLUSIONS Our study aimed to expand the currently limited evidence base for best practice in interventions for individuals at high risk of psychosis.
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Affiliation(s)
- Anthony P Morrison
- School of Psychological Sciences, University of Manchester, Manchester, UK.
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Kevan IM, Gumley AI, Coletta V. Post-traumatic stress disorder in a person with a diagnosis of schizophrenia: Examining the efficacy of psychological intervention using single N methodology. Clin Psychol Psychother 2007. [DOI: 10.1002/cpp.534] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Durham RC, Chambers JA, Power KG, Sharp DM, Macdonald RR, Major KA, Dow MG, Gumley AI. Long-term outcome of cognitive behaviour therapy clinical trials in central Scotland. Health Technol Assess 2005; 9:1-174. [PMID: 16266559 DOI: 10.3310/hta9420] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To establish the long-term outcome of participants in clinical trials of cognitive behaviour therapy (CBT) for anxiety disorders and psychosis, examining the effectiveness and cost-effectiveness associated with receiving CBT in comparison with alternative treatments. DESIGN An attempt was made to contact and interview all of the participants in eight randomised, controlled, clinical trials of CBT for anxiety disorders and two randomised, controlled, clinical trials of CBT for schizophrenia conducted between 1985 and 2001. Case note reviews of healthcare resources used in the 2 years prior to entering the trials and the 2 years prior to follow-up interview were undertaken. SETTING Mixed rural and urban settings in five localities in central Scotland. Anxiety disorder trials were conducted mainly in primary care and included three with generalised anxiety disorder, four with panic disorder and one with post-traumatic stress disorder (PTSD). The psychosis studies (one on relapse prevention and one with chronic disorder) were conducted in secondary care. PARTICIPANTS Of the 1071 entrants to the 10 studies, 489 agreed to participate (46% of original entrants, 52% of those available to contact). INTERVENTIONS Follow-up interviews took place between 1999 and 2003, 2-14 years after the original treatment. Interviews for Trials 1-8 were conducted by a research psychologist blind to original treatment condition. Interviews for Trials 9 and 10 were conducted by community psychiatric nurses also blind to treatment condition. Case note reviews were completed following the interview. MAIN OUTCOME MEASURES For Trials 1-8 the main interview-based outcome measures were: Anxiety Disorders Interview Schedule-DSM-IV for diagnosis and co-morbidity, Clinical Global Severity (0-8) and the Hamilton Anxiety Rating Scale. The main patient-rated measures were: Brief Symptom Inventory, SF-36 II, Clinical Global Improvement (1-7), and the Positive and Negative Affect Scale. For Trials 9 and 10 the primary outcome measure was the interview-based Positive and Negative Syndrome Scale (PANSS). RESULTS For the anxiety disorder studies (Trials 1-8), over half of the participants (52%) had at least one diagnosis at long-term follow-up, with significant levels of co-morbidity and health status scores comparable to the lowest 10% of the general population. Only 36% reported receiving no interim treatment for anxiety over the follow-up period with 19% receiving almost constant treatment. Patients with PTSD did particularly poorly. There was a 40% real increase in healthcare costs over the two time periods, mainly due to an increase in prescribing. A close relationship was found between poor mental and physical health for those with a chronic anxiety disorder. Treatment with CBT was associated with a better long-term outcome than non-CBT in terms of overall symptom severity but not with regard to diagnostic status. The positive effects of CBT found in the original trials were eroded over longer time periods. No evidence was found for an association between more intensive therapy and more enduring effects of CBT. Long-term outcome was found to be most strongly predicted by the complexity and severity of presenting problems at the time of referral, by completion of treatment irrespective of modality and by the amount of interim treatment during the follow-up period. The quality of the therapeutic alliance, measured in two of the studies, was not related to long-term outcome but was related to short-term outcome. The cost-effectiveness analysis showed no advantages of CBT over non-CBT. The cost of providing CBT in the original trials was only a very small proportion (6.4%) of the overall costs of healthcare for this population, which are high for both physical and mental health problems. In the psychosis studies (Trials 9 and 10), outcome was generally poor with only 10% achieving a 25% reduction in total PANSS scores from pretreatment to long-term follow-up, also cost-effectiveness analysis showed no advantages of CBT over non-CBT, although healthcare costs fell over the two time periods mainly owing to a reduction in inpatient costs. CONCLUSIONS Psychological therapy services need to recognise that anxiety disorders tend to follow a chronic course and that good outcomes with CBT over the short term are no guarantee of good outcomes over the longer term. Clinicians who go beyond standard treatment protocols of about 10 sessions over a 6-month period are unlikely to bring about greater improvement. Poor outcomes over the long term are related to greater complexity and severity of presenting problems at the time of referral, failure to complete treatment irrespective of modality and the amount of interim treatment during the follow-up period. The relative gains of CBT are greater in anxiety disorders than in psychosis. Longitudinal research designs over extended periods of time (2-5 years), with large numbers of participants (500+), are required to investigate the relative importance of patient characteristics, therapeutic alliance and therapist expertise in determining the cost-effectiveness of CBT in the longer term.
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Affiliation(s)
- R C Durham
- Psychiatry and Behavioural Sciences, Division of Pathology and Neuroscience, University of Dundee, Scotland, UK
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Sharp J, Wild MR, Gumley AI, Deighan CJ. A cognitive behavioral group approach to enhance adherence to hemodialysis fluid restrictions: a randomized controlled trial. Am J Kidney Dis 2005; 45:1046-57. [PMID: 15957134 DOI: 10.1053/j.ajkd.2005.02.032] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Adhering to fluid restrictions represents one of the most difficult aspects of the hemodialysis treatment regimen. This report describes a randomized controlled trial of a group-based cognitive behavioral intervention aimed at improving fluid-restriction adherence in patients receiving hemodialysis. It was hypothesized that the intervention would improve adherence, measured by means of interdialytic weight gain (IWG), without impacting negatively on psychosocial functioning. METHODS Fifty-six participants receiving hemodialysis from 4 renal outpatient settings were randomly assigned to an immediate-treatment group (ITG; n = 29) or deferred-treatment group (DTG; n = 27). Participants were assessed at baseline, posttreatment, and follow-up stages. Treatment consisted of a 4-week intervention using educational, cognitive, and behavioral strategies to enhance effective self-management of fluid consumption. RESULTS No significant difference in mean IWGs was found between the ITG and DTG during the acute-phase analysis (F(1,54) = 0.03; P > 0.05). However, in longitudinal analysis, there was a significant main effect for mean IWG (F(1.76,96.80) = 9.10; P < 0.001) and a significant difference between baseline and follow-up IWG values (t55 = 3.85; P < 0.001), reflecting improved adherence over time. No adverse effects of treatment were indicated through measures of psychosocial functioning. Some significant changes were evidenced in cognitions thought to be important in mediating behavioral change. CONCLUSION The current study provides evidence for the feasibility and effectiveness of applying group-based cognitive behavior therapy to enhance adherence to hemodialysis fluid restrictions. Results are discussed in the context of the study's methodological limitations.
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Affiliation(s)
- John Sharp
- Division of Community Based Sciences, University of Glasgow, Academic Centre, Gartnavel Royal Hospital, Lanarkshire, UK
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Abstract
In this review, we begin by highlighting the lack of available evidence to support current diagnostic criteria for psychophysiologic insomnia. We then outline 3 new testable candidate cognitive processes in psychophysiologic insomnia: attention bias, sleep effort, and metacognitive beliefs. Each candidate element is carefully described. Evidence of involvement in insomnia maintenance is discussed based on the existing literature. The need for an experimental research agenda to examine the interplay of these candidate cognitive processes is then emphasized. Research ideas are presented throughout our discussions.
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Sharp J, Wild MR, Gumley AI. A systematic review of psychological interventions for the treatment of nonadherence to fluid-intake restrictions in people receiving hemodialysis. Am J Kidney Dis 2005; 45:15-27. [PMID: 15696440 DOI: 10.1053/j.ajkd.2004.09.010] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Psychological interventions aimed at improving adherence to fluid-intake restrictions in patients receiving hemodialysis have become increasingly common. To the authors' knowledge, this is the first systematic review of the literature examining the impact of these interventions associated with patient interdialytic weight gain (IWG). METHODS A systematic search of the literature was performed on EMBASE, MEDLINE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and PsychINFO. The search was augmented by manually examining reference lists of reviews and retrieved reports. Study quality was graded according to criteria developed by the authors. Two additional independent researchers separately coded a random sample of studies to avoid bias of rating. RESULTS Sixteen studies were identified as eligible for inclusion. Relevant information from each included study was extracted and entered into a standardized table. Nearly all studies showed a postintervention decrease in IWG. A number of method weaknesses in the existing literature were identified. CONCLUSION Studies investigating psychological interventions aimed at improving adherence to fluid-intake restrictions appear to indicate some success in decreasing IWG. However, confidence regarding the validity of this finding is circumscribed by the prevalent use of investigative designs with inherently high susceptibility to bias. Future studies would benefit from using larger numbers of participants within controlled designs. Clearer description of intervention protocols would foster greater understanding of the contextual appropriateness of different approaches and which treatment components are key to improving adherence to fluid-intake restrictions in patients receiving hemodialysis.
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Affiliation(s)
- John Sharp
- Psychological Medicine, Division of Community Based Sciences, University of Glasgow, Glasgow, UK
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Gumley AI. Implicational meaning versus meaning implied by experience: a reply to Clarke (2002) introducing further developments towards an ICS formulation of psychosis. Clin Psychol Psychother 2002. [DOI: 10.1002/cpp.330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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