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Cowan HR, Williams TF, Mittal VA, Addington J, Bearden CE, Cadenhead KS, Cannon TD, Cornblatt BA, Keshevan M, Perkins DO, Mathalon DH, Stone W, Woods SW, Walker EF. The Complex Latent Structure of Attenuated Psychotic Symptoms: Hierarchical and Bifactor Models of SIPS Symptoms Replicated in Two Large Samples at Clinical High Risk for Psychosis. Schizophr Bull 2024:sbae042. [PMID: 38728417 DOI: 10.1093/schbul/sbae042] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
BACKGROUND AND HYPOTHESIS The Structured Interview for Psychosis-Risk Syndromes (SIPS) and other assessments of psychosis risk define clinical high risk for psychosis (CHR) by the presence of attenuated psychotic symptoms. Despite extensive research on attenuated psychotic symptoms, substantial questions remain about their internal psychometric structure and relationships to comorbid non-psychotic symptoms. STUDY DESIGN Hierarchical and bifactor models were developed for the SIPS in a large CHR sample (NAPLS-3, N = 787) and confirmed through preregistered replication in an independent sample (NAPLS-2, N = 1043). Criterion validity was tested through relationships with CHR status, comorbid symptoms/diagnoses, functional impairment, demographics, neurocognition, and conversion to psychotic disorders. STUDY RESULTS Most variance in SIPS items (75%-77%) was attributable to a general factor. Hierarchical and bifactor models included a general factor and five specific/lower-order factors (positive symptoms, eccentricity, avolition, lack of emotion, and deteriorated thought process). CHR participants were elevated on the general factor and the positive symptoms factor. The general factor was associated with depressive symptoms; functional impairment; and mood, anxiety, and schizotypal personality diagnoses. The general factor was the best predictor of psychotic disorders (d ≥ 0.50). Positive symptoms and eccentricity had specific effects on conversion outcomes. The deteriorated thought process was least meaningful/replicable. CONCLUSIONS Attenuated psychotic symptoms, measured by the SIPS, have a complex hierarchical structure with a strong general factor. The general factor relates to internalizing symptoms and functional impairment, emphasizing the roles of general psychopathological distress/impairment in psychosis risk. Shared symptom variance complicates the interpretation of raw symptom scores. Broad transdiagnostic assessment is warranted to model psychosis risk accurately.
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Affiliation(s)
- Henry R Cowan
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA
- Department of Psychology, Michigan State University, East Lansing, MI, USA
| | - Trevor F Williams
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - Vijay A Mittal
- Department of Psychology, Northwestern University, Evanston, IL, USA
- Departments of Psychiatry and Medical Social Sciences, Northwestern University, Evanston, IL, USA
| | - Jean Addington
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Carrie E Bearden
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
| | - Kristin S Cadenhead
- Department of Psychiatry, University of California San Diego, San Diego, USA
| | - Tyrone D Cannon
- Department of Psychology, Yale University, New Haven, CT, USA
- Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Barbara A Cornblatt
- Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, NY, USA
| | - Matcheri Keshevan
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts General Hospital, Boston, MA, USA
| | - Diana O Perkins
- Department of Psychiatry, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | - Daniel H Mathalon
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA
| | - William Stone
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts General Hospital, Boston, MA, USA
| | - Scott W Woods
- Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Elaine F Walker
- Department of Psychology, Emory University, Atlanta, GA, USA
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Lo Buglio G, Pontillo M, Cerasti E, Polari A, Schiano Lomoriello A, Vicari S, Lingiardi V, Boldrini T, Solmi M. A network analysis of anxiety, depressive, and psychotic symptoms and functioning in children and adolescents at clinical high risk for psychosis. Front Psychiatry 2022; 13:1016154. [PMID: 36386985 PMCID: PMC9650363 DOI: 10.3389/fpsyt.2022.1016154] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 09/21/2022] [Indexed: 11/13/2022] Open
Abstract
Objective Youths at clinical high risk for psychosis (CHR-P) are characterized by a high prevalence of anxiety and depressive disorders. The present study aimed at developing and analyzing a network structure of CHR-P symptom domains (i.e., positive, negative, disorganization, and general subclinical psychotic symptoms), depressive and anxiety symptoms, and general functioning. Methods Network analysis was applied to data on 111 CHR-P children and adolescents (M age = 14.1), who were assessed using the Structured Interview for Prodromal Syndromes, the Children's Depression Inventory, the Children's Global Assessment Scale, and the Multidimensional Anxiety Scale for Children. Results In the network, negative and disorganization symptoms showed the strongest association (r = 0.71), and depressive and anxiety symptoms showed dense within-domain connections, with a main bridging role played by physical symptoms of anxiety. The positive symptom cluster was not associated with any other node. The network stability coefficient (CS) was slightly below 0.25, and observed correlations observed ranged from 0.35 to 0.71. Conclusion The lack of association between subclinical positive symptoms and other network variables confirmed the independent nature of subclinical positive symptoms from comorbid symptoms, which were found to play a central role in the analyzed network. Complex interventions should be developed to target positive and comorbid symptoms, prioritizing those with the most significant impact on functioning and the most relevance for the young individual, through a shared decision-making process. Importantly, the results suggest that negative and disorganization symptoms, as well as depressive and anxiety symptoms, may be targeted simultaneously.
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Affiliation(s)
- Gabriele Lo Buglio
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Maria Pontillo
- Child Psychiatry Unit, Department of Neuroscience Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Erika Cerasti
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
- Istituto Nazionale di Statistica (Istat), Rome, Italy
| | - Andrea Polari
- Orygen Specialist Programs, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | | | - Stefano Vicari
- Child Psychiatry Unit, Department of Neuroscience Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
- Department of Life Science and Public Health, Catholic University of the Sacred Heart, Rome, Italy
| | - Vittorio Lingiardi
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Tommaso Boldrini
- Department of Developmental Psychology and Socialization, University of Padua, Padua, Italy
| | - Marco Solmi
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
- Department of Mental Health, The Ottawa Hospital, Ottawa, ON, Canada
- Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program University of Ottawa, Ottawa, ON, Canada
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
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Mensi MM, Molteni S, Iorio M, Filosi E, Ballante E, Balottin U, Fusar-Poli P, Borgatti R. Prognostic Accuracy of DSM-5 Attenuated Psychosis Syndrome in Adolescents: Prospective Real-World 5-Year Cohort Study. Schizophr Bull 2021; 47:1663-1673. [PMID: 33939829 PMCID: PMC8530398 DOI: 10.1093/schbul/sbab041] [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] [Indexed: 12/15/2022]
Abstract
There is limited research in adolescents at risk for psychosis. The new Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition attenuated psychosis syndrome (DSM-5 APS) criteria have not been validated in this group. We conducted a RECORD-compliant, real-world, prospective, 5-year cohort study addressing clinical profile, transition to psychosis, and prognostic accuracy of DSM-5 APS in help-seeking inpatient/outpatient adolescents accessing Children and Adolescent Neuropsychiatric services at IRCCS Mondino Foundation (Pavia, Lombardy, Italy) between 2012 and 2019. About 243 adolescents (31 early-onset psychosis [EOP]; 110 meeting DSM-5 APS criteria, DSM-5 APS; 102 not meeting psychotic or DSM-5 APS criteria, non-APS) were included. At baseline, DSM-5 APS adolescents (aged 15.4 ± 1.6) had on average 2.3 comorbid disorders (higher than EOP/non-APS, P < .001). DSM-5 APS adolescents had an intermediate psychopathological profile between non-APS/EOP (P < .001) and worsen Clinical Global Impression-Severity than non-APS (P < .001). DSM-5 APS functioning was intermediate between non-APS and EOP. 39.1% of DSM-5 APS were treated with psychotropic drugs (average = 64 days); 53.6% received psychotherapy. Follow-up of DSM-5 APS and non-APS groups lasted 33 and 26 months, respectively (median). The cumulative risk of transition at 1-5 years was 13%, 17%, 24.2%, 26.8%, and 26.8% in the DSM-5 APS group, 0%, 0%, 3.2%, 3.2%, and 3.2% in the non-APS group. The 5-year prognostic accuracy of the DSM-5 APS in adolescent was adequate (area under the curve = 0.77; Harrell's C = 0.736, 95%CI 0.697-0.775), with high sensitivity (91.3%) and suboptimal specificity (63.2%). The DSM-5 APS diagnosis can be used to detect help-seeking adolescents at risk of psychosis and predict their long-term outcomes. Future research should consolidate these findings.
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Affiliation(s)
- Martina Maria Mensi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy,Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Silvia Molteni
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy,Child Neuropsychiatry Unit, ASST Lariana, Como, Italy
| | - Melanie Iorio
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Eleonora Filosi
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Elena Ballante
- Department of Mathematics, University of Pavia, Pavia,Italy,BioData Science Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Umberto Balottin
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Paolo Fusar-Poli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy,Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK,OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK,To whom correspondence should be addressed; via Mondino 2, 27100 Pavia, Italy; tel: +390382430211, fax: +390382430236, e-mail:
| | - Renato Borgatti
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy,Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
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Straub KT, Hua JPY, Karcher NR, Kerns JG. Psychosis risk is associated with decreased white matter integrity in limbic network corticostriatal tracts. Psychiatry Res Neuroimaging 2020; 301:111089. [PMID: 32442837 PMCID: PMC7293570 DOI: 10.1016/j.pscychresns.2020.111089] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 04/14/2020] [Accepted: 04/15/2020] [Indexed: 02/06/2023]
Abstract
It is thought that altered connectivity between the striatum and the cortex could contribute to psychosis. However, whether psychosis risk is associated with altered white matter connectivity between the striatum and any cortical region is still unclear. Further, no previous study has directly examined whether psychosis risk is associated with altered striatal connectivity with specific cortical networks. The current study examined the integrity of corticostriatal white matter tracts in psychosis risk (n=18) and in non-psychosis risk comparison participants (n=19). We used probabilistic tractography to identify white matter tracts connecting each of four different striatal subregions with their most functionally connected cortical network: limbic, default mode, frontoparietal, and motor networks. We then compared groups on fractional anisotropy in these four tracts. Psychosis risk was associated with decreased fractional anisotropy in white matter tracts connecting the limbic striatum with the limbic cortical network, especially in an anterior right external capsule segment and in tracts specifically connected to the right prefrontal cortex. In contrast, psychosis risk was not associated with decreased white matter integrity in other corticostriatal tracts. Hence, the current research suggests that psychosis risk is especially associated with decreased corticostriatal white matter integrity involved in processing emotional and personally relevant information.
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Affiliation(s)
- Kelsey T Straub
- Department of Psychological Sciences, University of Missouri, Columbia, MO 65211, USA
| | - Jessica P Y Hua
- Department of Psychological Sciences, University of Missouri, Columbia, MO 65211, USA
| | - Nicole R Karcher
- Department of Psychological Sciences, University of Missouri, Columbia, MO 65211, USA; Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - John G Kerns
- Department of Psychological Sciences, University of Missouri, Columbia, MO 65211, USA.
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Jimeno N, Gomez-Pilar J, Poza J, Hornero R, Vogeley K, Meisenzahl E, Haidl T, Rosen M, Klosterkötter J, Schultze-Lutter F. Main Symptomatic Treatment Targets in Suspected and Early Psychosis: New Insights From Network Analysis. Schizophr Bull 2020; 46:884-895. [PMID: 32010940 PMCID: PMC7345824 DOI: 10.1093/schbul/sbz140] [Citation(s) in RCA: 14] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The early detection and intervention in psychoses prior to their first episode are presently based on the symptomatic ultra-high-risk and the basic symptom criteria. Current models of symptom development assume that basic symptoms develop first, followed by attenuated and, finally, frank psychotic symptoms, though interrelations of these symptoms are yet unknown. Therefore, we studied for the first time their interrelations using a network approach in 460 patients of an early detection service (mean age = 26.3 y, SD = 6.4; 65% male; n = 203 clinical high-risk [CHR], n = 153 first-episode psychosis, and n = 104 depression). Basic, attenuated, and frank psychotic symptoms were assessed using the Schizophrenia Proneness Instrument, Adult version (SPI-A), the Structured Interview for Psychosis-Risk Syndromes (SIPS), and the Positive And Negative Syndrome Scale (PANSS). Using the R package qgraph, network analysis of the altogether 86 symptoms revealed a single dense network of highly interrelated symptoms with 5 discernible symptom subgroups. Disorganized communication was the most central symptom, followed by delusions and hallucinations. In line with current models of symptom development, the network was distinguished by symptom severity running from SPI-A via SIPS to PANSS assessments. This suggests that positive symptoms developed from cognitive and perceptual disturbances included basic symptom criteria. Possibly conveying important insight for clinical practice, central symptoms, and symptoms "bridging" the association between symptom subgroups may be regarded as the main treatment targets, in order to prevent symptomatology from spreading or increasing across the whole network.
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Affiliation(s)
- Natalia Jimeno
- Department of Psychiatry, School of Medicine University of Valladolid, Valladolid, Spain
- Department of Psychiatry and Psychotherapy, Medical Faculty Heinrich-Heine University, Düsseldorf, Germany
- GINCS, Research Group on Clinical Neuroscience of Segovia, Segovia, Spain
| | - Javier Gomez-Pilar
- Biomedical Engineering Group, University of Valladolid, Valladolid, Spain
- CIBER-BBN, Centro de Investigacion Biomedica en Red-Bioingenieria, Biomateriales y Biomedicina, Valladolid, Spain
| | - Jesus Poza
- Biomedical Engineering Group, University of Valladolid, Valladolid, Spain
- CIBER-BBN, Centro de Investigacion Biomedica en Red-Bioingenieria, Biomateriales y Biomedicina, Valladolid, Spain
| | - Roberto Hornero
- Biomedical Engineering Group, University of Valladolid, Valladolid, Spain
- CIBER-BBN, Centro de Investigacion Biomedica en Red-Bioingenieria, Biomateriales y Biomedicina, Valladolid, Spain
| | - Kai Vogeley
- Department of Psychiatry, Faculty of Medicine and University Hospital Cologne University of Cologne, Cologne, Germany
- INM3, Institute of Neuroscience and Medicine, Research Center Jülich, Jülich, Germany
| | - Eva Meisenzahl
- Department of Psychiatry and Psychotherapy, Medical Faculty Heinrich-Heine University, Düsseldorf, Germany
| | - Theresa Haidl
- Department of Psychiatry, Faculty of Medicine and University Hospital Cologne University of Cologne, Cologne, Germany
| | - Marlene Rosen
- Department of Psychiatry, Faculty of Medicine and University Hospital Cologne University of Cologne, Cologne, Germany
| | - Joachim Klosterkötter
- Department of Psychiatry, Faculty of Medicine and University Hospital Cologne University of Cologne, Cologne, Germany
| | - Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty Heinrich-Heine University, Düsseldorf, Germany
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Abstract
BACKGROUND Psychosis risk is associated with striatal dysfunction, including a previous behavioral study that found that psychosis risk is associated with impaired performance on a probabilistic category learning task (PCLT; ie, the Weather Prediction Task), a task strongly associated with striatal activation. The current study examined whether psychosis risk based on symptom levels was associated with both poor behavioral performance and task-related physiological dysfunction in specific regions of the striatum while performing the PCLT. METHODS There were 2 groups of participants: psychosis risk (n = 21) who had both (a) extreme levels of self-reported psychotic-like beliefs and experiences and (b) interview-rated current attenuated psychotic symptoms (APS); and a comparison group (n = 20) who had average levels of self-reported psychotic-like beliefs and experiences. Participants completed the PCLT during fMRI scanning. RESULTS The current research replicated previous work finding behavioral PCLT deficits at the end of the task in psychosis risk. Furthermore, as expected, the psychosis risk group exhibited decreased striatal activation on the task, especially in the associative striatum. The psychosis risk group also displayed decreased activation in a range of cortical regions connected to the associative striatum. In contrast, the psychosis risk group exhibited greater activation predominantly in cortical regions not connected to the associative striatum. CONCLUSIONS Psychosis risk was associated with both behavioral and striatal dysfunction during performance on the PCLT, suggesting that behavioral and imaging measures using this task could be a marker for psychosis risk.
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Affiliation(s)
- Nicole R Karcher
- Department of Psychological Sciences, University of Missouri, Columbia, MO,Department of Psychiatry, Washington University School of Medicine, St. Louis, MO,To whom correspondence should be addressed; Department of Psychological Sciences, University of Missouri, 214 McAlester Hall, Columbia, MO 65211; tel: 573-882-8846, fax: 573-882-7710, e-mail:
| | - Jessica P Y Hua
- Department of Psychological Sciences, University of Missouri, Columbia, MO
| | - John G Kerns
- Department of Psychological Sciences, University of Missouri, Columbia, MO
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Rekhi G, Rapisarda A, Lee J. Impact of distress related to attenuated psychotic symptoms in individuals at ultra high risk of psychosis: Findings from the Longitudinal Youth at Risk Study. Early Interv Psychiatry 2019; 13:73-78. [PMID: 28560723 DOI: 10.1111/eip.12451] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 08/10/2016] [Revised: 02/08/2017] [Accepted: 03/18/2017] [Indexed: 12/21/2022]
Abstract
AIM Recent studies have highlighted that attenuated psychotic symptoms (APS) are an important source of distress in ultra high risk (UHR) individuals and that this distress is related to transition to psychosis (TTP). This study examined distress associated with APS in UHR individuals and investigated its association with TTP. METHODS The Comprehensive Assessment of At-Risk Mental State (CAARMS) was used to identify 173 UHR individuals, who were included as participants in the study. Distress related to APS was self-reported. Functioning was assessed on the Social and Occupational Functioning Assessment Scale. Associations between each of the 4 APS subscales in the CAARMS-non-bizarre ideas (NBI), perceptual abnormalities (PA), unusual thought content (UTC) and disorganized speech (DS)-with its distress level were examined. RESULTS Of the 173 UHR participants, 154 (89%) reported distress related to one or more APS. NBI was rated to be the most distressing out of the 4 APS by the highest number of participants (32.9%) compared to UTC (12.1%), PA (24.9%) and DS (2.9%). Mean distress scores were significantly associated with CAARMS composite scores (P < .001). However, there was no significant relationship between distress scores and functioning. Both mean distress scores (OR = 1.034, P = .029) and functioning (OR = 0.892, P = .022) were significant predictors of transition to psychosis at 1 year of follow-up. CONCLUSIONS This study provides additional evidence to link subjective distress experienced by UHR individuals to APS and to their subsequent clinical outcomes and has significant clinical implications.
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Affiliation(s)
- Gurpreet Rekhi
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Attilio Rapisarda
- Research Division, Institute of Mental Health, Singapore, Singapore.,Neuroscience & Behavioral Disorders, Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Jimmy Lee
- Research Division, Institute of Mental Health, Singapore, Singapore.,Department of General Psychiatry 1, Institute of Mental Health, Singapore, Singapore.,Office of Clinical Sciences, Duke-National University of Singapore Graduate Medical School, Singapore, Singapore
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Moriyama TS, van Os J, Gadelha A, Pan PM, Salum GA, Manfro GG, Mari JDJ, Miguel EC, Rohde LA, Polanczyk GV, McGuire P, Bressan RA, Drukker M. Differences Between Self-Reported Psychotic Experiences, Clinically Relevant Psychotic Experiences, and Attenuated Psychotic Symptoms in the General Population. Front Psychiatry 2019; 10:782. [PMID: 31736802 PMCID: PMC6829673 DOI: 10.3389/fpsyt.2019.00782] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [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: 05/22/2019] [Accepted: 10/01/2019] [Indexed: 12/26/2022] Open
Abstract
Purpose: Psychotic experiences in childhood (such as hearing voices or being suspicious) represent an important phenotype for early intervention. However, these experiences can be defined in several ways: self-reported psychotic experiences (SRPE) rely exclusively on the child's report, clinically validated psychotic experiences (CRPE) are based on clinical assessment, and attenuated psychotic symptoms (APS) represents a categorization to do with clinical relevance in relation to severity. Very few studies have investigated how these distinctions impact clinical and other domains. The present study aims to compare SRPE, CRPE, and APS among children and adolescents. Methods: This study is part of the Brazilian High-Risk Cohort Study for Psychiatric Disorders, in which 2,241 individuals aged 6-14 years provided self-ratings of 20 psychotic experiences using the Community Assessment of Psychic Experiences (CAPE). A trained psychologist conducted an interview to validate or reject reported experiences and to rate the presence of APS and affective flattening. In parallel, parents provided information about child mental health to an independent interviewer. We tested the association of mutually exclusive categories of non-validated SRPE (nSRPE), clinically validated PE below the threshold for APS (nCRPE), and APS (nSRPE = 33%, nCRPE = 11%, APS = 6%), with parents' information about the child's positive attributes and levels of psychopathology and psychologist assessment of blunted affect. Results: Most associations were qualitatively similar, and there was a dose-response in the strength of associations across categories, such that APS > nCRPE > nSRPE. Experiences in all three categories were associated with female sex. nSRPE were associated with overall levels of psychopathology, but to a lesser degree than nCRPE and APS. APS and nCRPE were associated with less positive attributes, with APS more so than nCRPE. Only APS was associated with affective flattening. Conclusions: In children and adolescents, SRPE, CRPE, and APS all index liability for psychopathology, but as clinician rated relevance increases, associations get stronger and become evident across more domains.
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Affiliation(s)
- Tais Silveira Moriyama
- Centro de Atendimento Especializado, Instituto Bairral de Psiquiatria, Itapira, Brazil.,Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil.,Brazilian High-Risk Cohort Study for Psychiatric Disorders, National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil.,Department of Psychiatry and Psychology, School of Mental Health and Neuroscience (MHeNS), Maastricht University Medical Centre (MUMC), Maastricht, Netherlands
| | - Jim van Os
- Department of Psychiatry and Psychology, School of Mental Health and Neuroscience (MHeNS), Maastricht University Medical Centre (MUMC), Maastricht, Netherlands.,Department of Psychosis Studies, King's College London, King's Health Partners, London, United Kingdom.,Department of Psychiatry, UMC Utrecht Brain Centre, Utrecht University Medical Centre, Utrecht, Netherlands
| | - Ary Gadelha
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil.,Brazilian High-Risk Cohort Study for Psychiatric Disorders, National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil
| | - Pedro Mario Pan
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil.,Brazilian High-Risk Cohort Study for Psychiatric Disorders, National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil
| | - Giovanni Abrahão Salum
- Brazilian High-Risk Cohort Study for Psychiatric Disorders, National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil.,Department of Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Gisele Gus Manfro
- Brazilian High-Risk Cohort Study for Psychiatric Disorders, National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil.,Department of Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Jair de Jesus Mari
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil.,Brazilian High-Risk Cohort Study for Psychiatric Disorders, National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil
| | - Eurípedes Constantino Miguel
- Brazilian High-Risk Cohort Study for Psychiatric Disorders, National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil.,Departamento de Psiquiatria, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Luis Augusto Rohde
- Brazilian High-Risk Cohort Study for Psychiatric Disorders, National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil.,Department of Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Guilherme Vanoni Polanczyk
- Brazilian High-Risk Cohort Study for Psychiatric Disorders, National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil.,Departamento de Psiquiatria, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Philip McGuire
- Department of Psychosis Studies, King's College London, King's Health Partners, London, United Kingdom
| | - Rodrigo Affonseca Bressan
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil.,Brazilian High-Risk Cohort Study for Psychiatric Disorders, National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil.,Department of Psychiatry and Psychology, School of Mental Health and Neuroscience (MHeNS), Maastricht University Medical Centre (MUMC), Maastricht, Netherlands
| | - Marjan Drukker
- Department of Psychiatry and Psychology, School of Mental Health and Neuroscience (MHeNS), Maastricht University Medical Centre (MUMC), Maastricht, Netherlands
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Cicero DC, Krieg A, Martin EA. Measurement Invariance of the Prodromal Questionnaire-Brief Among White, Asian, Hispanic, and Multiracial Populations. Assessment 2017; 26:294-304. [PMID: 28092988 DOI: 10.1177/1073191116687391] [Citation(s) in RCA: 20] [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] [Indexed: 11/16/2022]
Abstract
The Prodromal Questionnaire-Brief is a scale that is used to screen individuals for risk for the development of psychosis. It has promising psychometric properties in clinical and nonclinical populations, including undergraduates. However, the measurement invariance of the scale has not been examined in Asian, White, Hispanic, and Multiracial samples. A total of 2,767 undergraduates at two large public U.S. universities completed the Prodromal Questionnaire-Brief. The Total scores had configural and scalar invariance, while the Distress scores displayed configural, metric, and partial scalar invariance. Follow-up analyses revealed that three items were responsible for the lack of complete scalar invariance for the Distress scores. This suggests that the Total and Distress scores are measuring the same construct across groups and mean scores represent the same level of latent prodromal traits across groups. Mean comparisons for the Distress Scale across ethnicity should be interpreted with caution because it lacks complete scalar invariance. White and Hispanic participants had lower Total scores that Multiracial and Asian participants, and this pattern emerged for 13 items. For the distress items that were scalar invariant, the Asian group reported more distress than the White and Hispanic groups, while the Multiracial group reported more distress than the White group.
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Schmidt SJ, Schultze-Lutter F, Bendall S, Groth N, Michel C, Inderbitzin N, Schimmelmann BG, Hubl D, Nelson B. Mediators Linking Childhood Adversities and Trauma to Suicidality in Individuals at Risk for Psychosis. Front Psychiatry 2017; 8:242. [PMID: 29249990 PMCID: PMC5715383 DOI: 10.3389/fpsyt.2017.00242] [Citation(s) in RCA: 14] [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: 06/21/2017] [Accepted: 11/06/2017] [Indexed: 12/29/2022] Open
Abstract
Suicidality is highly prevalent in patients at clinical high risk (CHR) for psychosis. Childhood adversities and trauma are generally predictive of suicidality. However, the differential effects of adversity/trauma-domains and CHR-criteria, i.e., ultra-high risk and basic symptom criteria, on suicidality remain unclear. Furthermore, the underlying mechanisms and, thus, worthwhile targets for suicide-prevention are still poorly understood. Therefore, structural equation modeling was used to test theory-driven models in 73 CHR-patients. Mediators were psychological variables, i.e., beliefs about one's own competencies as well as the controllability of events and coping styles. In addition, symptomatic variables (depressiveness, basic symptoms, attenuated psychotic symptoms) were hypothesized to mediate the effect of psychological mediators on suicidality as the final outcome variable. Results showed two independent pathways. In the first pathway, emotional and sexual but not physical adversity/trauma was associated with suicidality, which was mediated by dysfunctional competence/control beliefs, a lack of positive coping-strategies and depressiveness. In the second pathway, cognitive basic symptoms but not attenuated psychotic symptoms mediated the relationship between trauma/adversity and suicidality. CHR-patients are, thus, particularly prone to suicidality if adversity/trauma is followed by the development of depressiveness. Regarding the second pathway, this is the first study showing that adversity/trauma led to suicidality through an increased risk for psychosis as indicated by cognitive basic symptoms. As insight is generally associated with suicidality, this may explain why self-experienced basic symptoms increase the risk for it. Consequently, these mediators should be monitored regularly and targeted by integrated interventions as early as possible to enhance resilience against suicidality.
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Affiliation(s)
- Stefanie J Schmidt
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.,Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - 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
| | - Sarah Bendall
- Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Nicola Groth
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Chantal Michel
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.,Developmental Clinical Psychology Research Unit, Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
| | - Nadja Inderbitzin
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Benno G Schimmelmann
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.,University Hospital of Child and Adolescent Psychiatry, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Daniela Hubl
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Barnaby Nelson
- Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
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Schimmelmann BG, Michel C, Martz-Irngartinger A, Linder C, Schultze-Lutter F. Age matters in the prevalence and clinical significance of ultra-high-risk for psychosis symptoms and criteria in the general population: Findings from the BEAR and BEARS-kid studies. World Psychiatry 2015; 14:189-97. [PMID: 26043337 PMCID: PMC4471976 DOI: 10.1002/wps.20216] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [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] [Indexed: 02/06/2023] Open
Abstract
Early detection of psychosis is an important topic in psychiatry. Yet, there is limited information on the prevalence and clinical significance of high-risk symptoms in children and adolescents as compared to adults. We examined ultra-high-risk (UHR) symptoms and criteria in a sample of individuals aged 8-40 years from the general population of Canton Bern, Switzerland, enrolled from June 2011 to May 2014. The current presence of attenuated psychotic symptoms (APS) and brief intermittent psychotic symptoms (BLIPS) and the fulfillment of onset/worsening and frequency requirements for these symptoms in UHR criteria were assessed using the Structured Interview for Psychosis Risk Syndromes. Additionally, perceptive and non-perceptive APS were differentiated. Psychosocial functioning and current non-psychotic DSM-IV axis I disorders were also surveyed. Well-trained psychologists performed assessments. Altogether, 9.9% of subjects reported APS and none BLIPS, and 1.3% met all the UHR requirements for APS. APS were related to more current axis I disorders and impaired psychosocial functioning, indicating some clinical significance. A strong age effect was detected around age 16: compared to older individuals, 8-15-year olds reported more perceptive APS, that is, unusual perceptual experiences and attenuated hallucinations. Perceptive APS were generally less related to functional impairment, regardless of age. Conversely, non-perceptive APS were related to low functioning, although this relationship was weaker in those below age 16. Future studies should address the differential effects of perceptive and non-perceptive APS, and their interaction with age, also in terms of conversion to psychosis.
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Affiliation(s)
- Benno G Schimmelmann
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of BernBolligenstrasse 111, 3000 Bern 60, Switzerland
| | - Chantal Michel
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of BernBolligenstrasse 111, 3000 Bern 60, Switzerland
| | - Alexandra Martz-Irngartinger
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of BernBolligenstrasse 111, 3000 Bern 60, Switzerland
| | - Caroline Linder
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of BernBolligenstrasse 111, 3000 Bern 60, Switzerland
| | - Frauke Schultze-Lutter
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of BernBolligenstrasse 111, 3000 Bern 60, Switzerland
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Miklowitz DJ, O’Brien MP, Schlosser DA, Addington J, Candan KA, Marshall C, Domingues I, Walsh BC, Zinberg JL, De Silva SD, Friedman-Yakoobian M, Cannon TD. Family-focused treatment for adolescents and young adults at high risk for psychosis: results of a randomized trial. J Am Acad Child Adolesc Psychiatry 2014; 53:848-58. [PMID: 25062592 PMCID: PMC4112074 DOI: 10.1016/j.jaac.2014.04.020] [Citation(s) in RCA: 108] [Impact Index Per Article: 10.8] [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: 10/08/2013] [Revised: 04/11/2014] [Accepted: 05/13/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Longitudinal studies have begun to clarify the phenotypic characteristics of adolescents and young adults at clinical high risk for psychosis. This 8-site randomized trial examined whether a 6-month program of family psychoeducation was effective in reducing the severity of attenuated positive and negative psychotic symptoms and enhancing functioning among individuals at high risk. METHOD Adolescents and young adults (mean age 17.4 ± 4.1 years) with attenuated positive psychotic symptoms, brief and intermittent psychosis, or genetic risk with functional deterioration were randomly assigned to 18 sessions of family-focused therapy for individuals at clinical high risk (FFT-CHR) in 6 months or 3 sessions of family psychoeducation (enhanced care [EC]). FFT-CHR included psychoeducation about early signs of psychosis, stress management, communication training, and problem-solving skills training, whereas EC focused on symptom prevention. Independent evaluators assessed participants at baseline and 6 months on positive and negative symptoms and social-role functioning. RESULTS Of 129 participants, 102 (79.1%) were followed up at 6 months. Participants in FFT-CHR showed greater improvements in attenuated positive symptoms over 6 months than participants in EC (F1,97 = 5.49, p = .02). Negative symptoms improved independently of psychosocial treatments. Changes in psychosocial functioning depended on age: participants more than 19 years of age showed more role improvement in FFT-CHR, whereas participants between 16 and 19 years of age showed more role improvement in EC. The results were independent of concurrent pharmacotherapy. CONCLUSION Interventions that focus on improving family relationships may have prophylactic efficacy in individuals at high risk for psychosis. Future studies should examine the specificity of effects of family intervention compared to individual therapy of the same duration and frequency. Clinical trial registration information-Prevention Trial of Family Focused Treatment in Youth at Risk for Psychosis; http://clinicaltrials.gov/; NCT01907282.
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Affiliation(s)
- David J. Miklowitz
- University of California, Los Angles (UCLA) School of Medicine, Los Angeles, CA
| | | | | | - Jean Addington
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta
| | | | | | | | | | - Jamie L. Zinberg
- University of California, Los Angles (UCLA) School of Medicine, Los Angeles, CA
| | - Sandra D. De Silva
- University of California, Los Angles (UCLA) School of Medicine, Los Angeles, CA
| | - Michelle Friedman-Yakoobian
- Mental Health Center Division of Public Psychiatry, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, MA
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Ising HK, Veling W, Loewy RL, Rietveld MW, Rietdijk J, Dragt S, Klaassen RMC, Nieman DH, Wunderink L, Linszen DH, van der Gaag M. The validity of the 16-item version of the Prodromal Questionnaire (PQ-16) to screen for ultra high risk of developing psychosis in the general help-seeking population. Schizophr Bull 2012; 38:1288-96. [PMID: 22516147 PMCID: PMC3713086 DOI: 10.1093/schbul/sbs068] [Citation(s) in RCA: 262] [Impact Index Per Article: 21.8] [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] [Indexed: 11/13/2022]
Abstract
In order to bring about implementation of routine screening for psychosis risk, a brief version of the Prodromal Questionnaire (PQ; Loewy et al., 2005) was developed and tested in a general help-seeking population. We assessed a consecutive patient sample of 3533 young adults who were help-seeking for nonpsychotic disorders at the secondary mental health services in The Hague with the PQ. We performed logistic regression analyses and CHi-squared Automatic Interaction Detector decision tree analysis to shorten the original 92 items. Receiver operating characteristic curves were used to examine the psychometric properties of the PQ-16. In the general help-seeking population, a cutoff score of 6 or more positively answered items on the 16-item version of the PQ produced correct classification of Comprehensive Assessment of At-Risk Mental State (Yung et al., 2005) psychosis risk/clinical psychosis in 44% of the cases, distinguishing Comprehensive Assessment of At-Risk Mental States (CAARMS) diagnosis from no CAARMS diagnosis with high sensitivity (87%) and specificity (87%). These results were comparable to the PQ-92. The PQ-16 is a good self-report screen for use in secondary mental health care services to select subjects for interviewing for psychosis risk. The low number of items makes it quite appropriate for screening large help-seeking populations, thus enhancing the feasibility of detection and treatment of ultra high-risk patients in routine mental health services.
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Affiliation(s)
- Helga K. Ising
- Department of Psychiatry, Parnassia Psychiatric Institute, Prinsegracht 63-65, 2512 EX, The Hague, The Netherlands,To whom correspondence should be addressed; tel: +31653935513, fax: +31883584315, e-mail:
| | - Wim Veling
- Department of Psychiatry, Parnassia Psychiatric Institute, Prinsegracht 63-65, 2512 EX, The Hague, The Netherlands
| | - Rachel L. Loewy
- Department of Psychiatry, University of California at San Francisco, San Francisco, CA
| | - Marleen W. Rietveld
- Department of Psychiatry, Parnassia Psychiatric Institute, Prinsegracht 63-65, 2512 EX, The Hague, The Netherlands
| | - Judith Rietdijk
- VU University and EMGO+ Institute for Health and Care Research, Amsterdam, The Netherlands
| | - Sara Dragt
- Department of Psychiatry, Academic Medical Center, Amsterdam, The Netherlands
| | - Rianne M. C. Klaassen
- Department of Children and Adolescent Care, GGZ Rivierduinen, Leiden, The Netherlands
| | - Dorien H. Nieman
- Department of Psychiatry, Academic Medical Center, Amsterdam, The Netherlands
| | - Lex Wunderink
- Department of Education and Research, GGZ Friesland, Leeuwarden, The Netherlands
| | - Don H. Linszen
- Department of Psychiatry, Academic Medical Center, Amsterdam, The Netherlands
| | - Mark van der Gaag
- Department of Psychiatry, Parnassia Psychiatric Institute, Prinsegracht 63-65, 2512 EX, The Hague, The Netherlands,VU University and EMGO+ Institute for Health and Care Research, Amsterdam, The Netherlands
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