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Jensen KM, Calhoun VD, Fu Z, Yang K, Faria AV, Ishizuka K, Sawa A, Andrés-Camazón P, Coffman BA, Seebold D, Turner JA, Salisbury DF, Iraji A. A whole-brain neuromark resting-state fMRI analysis of first-episode and early psychosis: Evidence of aberrant cortical-subcortical-cerebellar functional circuitry. Neuroimage Clin 2024; 41:103584. [PMID: 38422833 PMCID: PMC10944191 DOI: 10.1016/j.nicl.2024.103584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 01/31/2024] [Accepted: 02/25/2024] [Indexed: 03/02/2024]
Abstract
Psychosis (including symptoms of delusions, hallucinations, and disorganized conduct/speech) is a main feature of schizophrenia and is frequently present in other major psychiatric illnesses. Studies in individuals with first-episode (FEP) and early psychosis (EP) have the potential to interpret aberrant connectivity associated with psychosis during a period with minimal influence from medication and other confounds. The current study uses a data-driven whole-brain approach to examine patterns of aberrant functional network connectivity (FNC) in a multi-site dataset comprising resting-state functional magnetic resonance images (rs-fMRI) from 117 individuals with FEP or EP and 130 individuals without a psychiatric disorder, as controls. Accounting for age, sex, race, head motion, and multiple imaging sites, differences in FNC were identified between psychosis and control participants in cortical (namely the inferior frontal gyrus, superior medial frontal gyrus, postcentral gyrus, supplementary motor area, posterior cingulate cortex, and superior and middle temporal gyri), subcortical (the caudate, thalamus, subthalamus, and hippocampus), and cerebellar regions. The prominent pattern of reduced cerebellar connectivity in psychosis is especially noteworthy, as most studies focus on cortical and subcortical regions, neglecting the cerebellum. The dysconnectivity reported here may indicate disruptions in cortical-subcortical-cerebellar circuitry involved in rudimentary cognitive functions which may serve as reliable correlates of psychosis.
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Affiliation(s)
- Kyle M Jensen
- Georgia State University, Atlanta, GA, USA; Tri-Institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Atlanta, GA, USA.
| | - Vince D Calhoun
- Georgia State University, Atlanta, GA, USA; Tri-Institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Atlanta, GA, USA
| | - Zening Fu
- Georgia State University, Atlanta, GA, USA; Tri-Institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Atlanta, GA, USA
| | - Kun Yang
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andreia V Faria
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Koko Ishizuka
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Akira Sawa
- Johns Hopkins University School of Medicine, Baltimore, MD, USA; Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Pablo Andrés-Camazón
- Tri-Institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Atlanta, GA, USA; Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, Madrid, Spain
| | - Brian A Coffman
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Dylan Seebold
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jessica A Turner
- Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Dean F Salisbury
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Armin Iraji
- Georgia State University, Atlanta, GA, USA; Tri-Institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Atlanta, GA, USA
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Ribeiro WS, Romeo R, King D, Owens S, Gronholm PC, Fisher HL, Laurens KR, Evans-Lacko S. Influence of stigma, sociodemographic and clinical characteristics on mental health-related service use and associated costs among young people in the United Kingdom. Eur Child Adolesc Psychiatry 2023; 32:1363-1373. [PMID: 35088184 PMCID: PMC10326138 DOI: 10.1007/s00787-022-01947-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 01/11/2022] [Indexed: 11/03/2022]
Abstract
This study examined the influence of stigma, psychopathology, and sociodemographic characteristics on mental health-related service use and costs related to service use in a cohort of young people in the UK. Using data from a community sample of young people aged 9-17 years and their caregivers, we assessed 407 young people's use of services due to mental health problems, young people's psychopathology, demographic characteristics, maternal education and caregivers' stigma-related beliefs. Unit costs related to services were gathered from national annual compendia and other widely used sources. We assessed predictors of service use through logistic regression analysis and developed generalised linear models to identify factors associated with costs of mental health-related service utilisation. Persistent psychopathology, socioeconomic disadvantage, and low caregiver intended stigma-related behaviour were associated with increased likelihood of service use among young people. Older age and socioeconomic disadvantage were associated with increased costs. Different factors influenced contact with services and the cost associated with their use - persistent psychopathology and socioeconomic disadvantage increased, and caregivers' intended stigma-related behaviour decreased the likelihood of using services, whereas socioeconomic disadvantage and older age were associated with increased costs. Social determinants of mental health problems play an important role in the use and costs of different types of mental health-related services for young people. Discordance between drivers of service use and costs implies that young people who are more likely to access services due to mental health problems do not necessarily receive care at the intensity they need.
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Affiliation(s)
- Wagner Silva Ribeiro
- Care Policy and Evaluation Centre, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK.
| | - Renee Romeo
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Derek King
- Care Policy and Evaluation Centre, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK
| | | | - Petra C Gronholm
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Helen L Fisher
- Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Kristin R Laurens
- School of Psychology and Counselling, Queensland University of Technology (QUT), Brisbane, Australia
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Sara Evans-Lacko
- Care Policy and Evaluation Centre, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK
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Gutteridge TP, Kelly AB, Laurens KR. Increased likelihood of distressing and functionally impairing psychotic-like experiences among children with co-occurring internalising and externalising problems. Schizophr Res 2023; 252:225-230. [PMID: 36681045 DOI: 10.1016/j.schres.2023.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 01/01/2023] [Accepted: 01/07/2023] [Indexed: 01/20/2023]
Abstract
Among children with psychotic-like experiences (PLEs), the presence of co-occurring psychopathology may distinguish children's self-report of clinically significant experiences (i.e., PLEs that are distressing and/or impairing of daily functioning) from reports of more benign experiences. The aim of this study was to examine whether the likelihood of distressing or impairing PLEs differed according to type of co-occurring psychopathology symptoms. A community sample of 5268 children aged 9-12 years were recruited from Greater London, UK. Participants completed the Psychotic-Like Experiences Questionnaire for Children, and the Strengths and Difficulties Questionnaire to measure internalising and externalising problems. Multinomial logistic regressions were used to determine the likelihood of PLEs being distressing and/or impairing (vs. not) among children with different co-occurring symptom profiles (PLEs only; PLEs with internalising problems only - PLE-I; PLEs with externalising problems only - PLE-E; and PLEs with both internalising and externalising problems - PLE-IE). Children with co-occurring internalising and/or externalising problems had greater odds of distressing and/or impairing PLEs compared to children without co-occurring psychopathology (PLEs only). These associations were moderate for PLE-E and strong for PLE-I and PLE-IE, with the greatest odds of distressing and impairing PLEs evident in the presence of internalising plus externalising comorbidities (odds ratios [with 99 % confidence intervals] for PLE-IE relative to PLE-I = 2.00 [1.34-2.99]; PLE-IE relative to PLE-E = 5.46 [3.78-7.90]). These results affirm the importance of screening for the presence and type of co-occurring psychopathology among children with PLEs to demarcate potentially different treatment needs.
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Affiliation(s)
- Tiffany P Gutteridge
- Queensland University of Technology (QUT), School of Psychology and Counselling, Brisbane, QLD, Australia
| | - Adrian B Kelly
- Queensland University of Technology (QUT), School of Psychology and Counselling, Brisbane, QLD, Australia; Queensland University of Technology (QUT), Centre for Child Health and Well-being, Brisbane, QLD, Australia; Queensland University of Technology (QUT), Centre for Inclusive Education (C4IE), Brisbane, QLD, Australia
| | - Kristin R Laurens
- Queensland University of Technology (QUT), School of Psychology and Counselling, Brisbane, QLD, Australia; Queensland University of Technology (QUT), Centre for Child Health and Well-being, Brisbane, QLD, Australia; Queensland University of Technology (QUT), Centre for Inclusive Education (C4IE), Brisbane, QLD, Australia; King's College London, Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, London, UK.
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Matheson SL, Laurie M, Laurens KR. Substance use and psychotic-like experiences in young people: a systematic review and meta-analysis. Psychol Med 2023; 53:305-319. [PMID: 36377500 PMCID: PMC9899577 DOI: 10.1017/s0033291722003440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/23/2022] [Accepted: 10/12/2022] [Indexed: 11/16/2022]
Abstract
This study aimed to systematically review and synthesise the available evidence on the prevalence and associations between psychotic-like experiences (PLEs) and substance use in children and adolescents aged ⩽17 years, prior to the typical age of development of prodromal symptoms of psychosis. As substance use has been associated with earlier age of psychosis onset and more severe illness, identifying risk processes in the premorbid phase of the illness may offer opportunities to prevent the development of prodromal symptoms and psychotic illness. MEDLINE, PsycINFO, and CINAHL databases were searched for chart review, case-control, cohort, twin, and cross-sectional studies. Study reporting was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist, and pooled evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Searches identified 55 studies that met inclusion criteria. Around two-in-five substance users reported PLEs [rate = 0.41, 95% confidence interval (CI) 0.32-0.51; low quality evidence], and one-in-five with PLEs reported using substances (rate = 0.19, 95% CI 0.12-0.28; moderate-to-high quality evidence). Substance users were nearly twice as likely to report PLEs than non-users [odds ratio (OR) 1.77, 95% CI 1.55-2.02; moderate quality evidence], and those with PLEs were twice as likely to use substances than those not reporting PLEs (OR 1.93, 95% CI 1.55-2.41; very low quality evidence). Younger age was associated with greater odds of PLEs in substance users compared to non-users. Young substance users may represent a subclinical at-risk group for psychosis. Developing early detection and intervention for both substance use and PLEs may reduce long-term adverse outcomes.
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Affiliation(s)
- Sandra L. Matheson
- Discipline of Psychiatry and Mental Health, University of New South Wales (UNSW), Sydney, Australia
- Neuroscience Research Australia (NeuRA), Sydney, Australia
- National Drug and Alcohol Research Centre (NDARC), Sydney, Australia
| | - Mallory Laurie
- School of Behavioural and Health Sciences, Australian Catholic University, Brisbane, Australia
| | - Kristin R. Laurens
- Discipline of Psychiatry and Mental Health, University of New South Wales (UNSW), Sydney, Australia
- School of Psychology and Counselling, Queensland University of Technology (QUT), Brisbane, Australia
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Karcher NR, Klaunig MJ, Elsayed NM, Taylor RL, Jay SY, Schiffman J. Understanding Associations Between Race/Ethnicity, Experiences of Discrimination, and Psychotic-like Experiences in Middle Childhood. J Am Acad Child Adolesc Psychiatry 2022; 61:1262-1272. [PMID: 35378237 PMCID: PMC9525459 DOI: 10.1016/j.jaac.2022.03.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 01/06/2022] [Accepted: 03/25/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVE The present study aimed to examine factors that may account for race/ethnicity differences in psychotic-like experiences (PLEs) in a middle childhood sample, including evidence for experiences of discrimination as a psychosocial mediator of these differences. METHOD In a sample of 9- to 10-year-olds (N = 10,839) from the Adolescent Brain Cognitive Development Study, we compared PLEs across racial/ethnic groups. We also examined whether experiences of discrimination indirectly linked racial/ethnic identity and PLEs and whether social support moderated this indirect association. RESULTS Differences between racial/ethnic groups were found in the endorsement of PLEs, such that Black and Hispanic participants endorsed higher levels of PLEs compared with Asian, multiracial/multiethnic, and White participants. These differences were accounted for in part by experiences of discrimination, an indirect effect that was in turn attenuated by increased social support. CONCLUSION This is the first study to suggest that the experience of discrimination may indirectly link the association between racial/ethnic differences and endorsement of PLEs using the Prodromal Questionnaire-Brief Child Version and additionally that social support may act as a moderator of this mediation. Results provide evidence that social inequities such as racial discrimination may contribute to increases in PLEs. These findings shed further light on the links between structural racism and mental health inequities for people in minoritized groups.
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Affiliation(s)
| | - Mallory J Klaunig
- University of Maryland, Baltimore County; University of California, Irvine
| | | | | | | | - Jason Schiffman
- University of Maryland, Baltimore County; University of California, Irvine
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Karcher NR, Merchant J, Pine J, Kilciksiz CM. Cognitive Dysfunction as a Risk Factor for Psychosis. Curr Top Behav Neurosci 2022; 63:173-203. [PMID: 35989398 DOI: 10.1007/7854_2022_387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The current chapter summarizes recent evidence for cognition as a risk factor for the development of psychosis, including the range of cognitive impairments that exist across the spectrum of psychosis risk symptoms. The chapter examines several possible theories linking cognitive deficits with the development of psychotic symptoms, including evidence that cognitive deficits may be an intermediate risk factor linking genetic and/or neural metrics to psychosis spectrum symptoms. Although there is not strong evidence for unique cognitive markers associated specifically with psychosis compared to other forms of psychopathology, psychotic disorders are generally associated with the greatest severity of cognitive deficits. Cognitive deficits precede the development of psychotic symptoms and may be detectable as early as childhood. Across the psychosis spectrum, both the presence and severity of psychotic symptoms are associated with mild to moderate impairments across cognitive domains, perhaps most consistently for language, cognitive control, and working memory domains. Research generally indicates the size of these cognitive impairments worsens as psychosis symptom severity increases. The chapter points out areas of unclarity and unanswered questions in each of these areas, including regarding the mechanisms contributing to the association between cognition and psychosis, the timing of deficits, and whether any cognitive systems can be identified that function as specific predictors of psychosis risk symptoms.
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Affiliation(s)
- Nicole R Karcher
- Department of Psychiatry, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA.
| | - Jaisal Merchant
- Department of Brain and Psychological Sciences, Washington University in St. Louis, St. Louis, MO, USA
| | - Jacob Pine
- Department of Brain and Psychological Sciences, Washington University in St. Louis, St. Louis, MO, USA
| | - Can Misel Kilciksiz
- Department of Psychiatry, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
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Okamoto JN, Martins MLWG, Henna Neto J. A vitamina C na esquizofrenia apresenta benefício? Estudo preliminar com análise comportamental em ratos. JORNAL BRASILEIRO DE PSIQUIATRIA 2022. [DOI: 10.1590/0047-2085000000373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
RESUMO Objetivo O objetivo deste estudo foi analisar em ratos modelos de esquizofrenia, induzidos pela administração de cetamina, a possibilidade dos efeitos benéficos do ácido ascórbico na esquizofrenia, por meio do teste comportamental. Métodos O estudo preliminar foi simples-cego e randomizado. Foi realizado o protocolo de psicose por cetamina em 24 ratos Wistar submetidos posteriormente à análise comportamental. No primeiro grupo, foram administradas: água e cetamina; no segundo: ácido ascórbico e cetamina; no terceiro: antipsicótico, ácido ascórbico e cetamina; e no quarto: antipsicótico, água e cetamina. A análise comportamental foi feita por meio do Open Field Test, considerado o método-padrão para avaliar comportamento em modelos animais de esquizofrenia. A análise estatística foi realizada pelo software IBM-SPSS, por meio dos Modelos Lineares Generalizados. Resultados O tratamento em monoterapia de haloperidol (Média Quadrante: 44,5 ± 15,8; IC: 13,54-75,46/Média Centro: 2,67 ± 0,67; IC: 1,63-4,35) e aquele em conjunto com a vitamina C (Média Quadrante: 38,67 ± 15,8; IC: 7,71-69,52/Média Centro: 2,00 ± 0,58; IC: 1,14-3,52) demonstraram benefícios nos ratos modelos de esquizofrenia induzidos por cetamina (Média Quadrante: 108,5 ± 15,8; IC: 77,54-139,46/Média Centro: 11,33 ± 1,37; IC: 8,94-14,37) (p < 0,001). O tratamento isolado com a vitamina C não apresentou resultado significante (Média Quadrante: 62,00 ± 15,8; IC: 31,04-92,96/Média Centro: 7,00 ± 1,08; IC: 5,17-9,47). Conclusão A associação de antipsicótico e vitamina C e somente o antipsicótico demonstraram efeito terapêutico em relação aos controles. A vitamina C isolada não apresentou benefício.
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Carpendale EJ, Cullen AE, Dickson H, Laurens KR. Dissociable impairments of verbal learning differentiate childhood risk profiles for schizophrenia. Schizophr Res Cogn 2022; 28:100239. [PMID: 35242608 PMCID: PMC8861403 DOI: 10.1016/j.scog.2022.100239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 01/24/2022] [Accepted: 01/26/2022] [Indexed: 11/18/2022] Open
Abstract
Poor verbal learning and memory function is well-documented among individuals with schizophrenia and those at clinical high-risk for psychosis. This study aimed to identify these impairments among children aged 9–12 years with different schizophrenia risk profiles (family history or antecedents of schizophrenia, each of higher[H] or lower[L] risk load) relative to typically developing peers. These three groups were recruited via community-screening, and differentiated for analysis into: typically developing children (TD = 45); children who had 1 first- or ≥2 second-degree affected relatives (FHxH = 16) or one second-degree relative (FHxL = 15); and children presenting multiple replicated antecedents of schizophrenia whose clinical symptoms persisted at 2- and/or 4-year follow-up (ASzH = 16) or remitted during follow-up (ASzL = 16). Verbal learning/memory measures assessed at baseline (age 9–12 years) included: (i) total recall; (ii) trial 1 recall; (iii) learning score; (iv) intrusions; (v) total words lost; and (vi) serial position patterns. Analyses of variance indicated that FHxH and ASzH youth demonstrated impaired total recall compared to TD and ASzL children and lost significantly more words between trials than TD and FHxL children. Learning score was impaired among both FHxH and FHxL relative to TD and ASzL children. Thus, among putatively at-risk children, total words recalled and lost distinguished those with higher risk load (by family history or persistent antecedent symptomology), whereas learning score indexed familial vulnerability. Follow-up of the sample is needed to determine the capacity of verbal learning deficits to predict later illness and provide a potential avenue for early remediation to improve clinical or functional outcomes.
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Affiliation(s)
- Emma J. Carpendale
- Queensland University of Technology (QUT), School of Psychology and Counselling, Brisbane, Queensland, Australia
| | - Alexis E. Cullen
- King's College London, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
| | - Hannah Dickson
- King's College London, Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
| | - Kristin R. Laurens
- Queensland University of Technology (QUT), School of Psychology and Counselling, Brisbane, Queensland, Australia
- King's College London, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
- University of New South Wales, School of Psychiatry, Sydney, New South Wales, Australia
- Corresponding author at: School of Psychology and Counselling, O Block, B Wing, Level 5, Queensland University of Technology, Victoria Park Road, Kelvin Grove, QLD 4059, Australia.
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Yamaguchi R, Matsudaira I, Takeuchi H, Imanishi T, Kimura R, Tomita H, Kawashima R, Taki Y. RELN rs7341475 associates with brain structure in japanese healthy females. Neuroscience 2022; 494:38-50. [DOI: 10.1016/j.neuroscience.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 04/06/2022] [Accepted: 05/06/2022] [Indexed: 11/25/2022]
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Karcher NR, Loewy RL, Savill M, Avenevoli S, Huber RS, Makowski C, Sher KJ, Barch DM. Persistent and distressing psychotic-like experiences using adolescent brain cognitive development℠ study data. Mol Psychiatry 2022; 27:1490-1501. [PMID: 34782711 PMCID: PMC9106814 DOI: 10.1038/s41380-021-01373-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 10/18/2021] [Accepted: 10/20/2021] [Indexed: 02/03/2023]
Abstract
Childhood psychotic-like experiences (PLEs) are associated with a range of impairments; a subset of children experiencing PLEs will develop psychiatric disorders, including psychotic disorders. A potential distinguishing factor between benign PLEs versus PLEs that are clinically relevant is whether PLEs are distressing and/or persistent. The current study used three waves of Adolescent Brain Cognitive Development℠ (ABCD) study PLEs assessments to examine the extent to which persistent and/or distressing PLEs were associated with relevant baseline risk factors (e.g., cognition) and functioning/mental health service utilization domains. Four groups varying in PLE persistence and distress endorsement were created based on all available data in ABCD Release 3.0, with group membership not contingent on complete data: persistent distressing PLEs (n = 272), transient distressing PLEs (n = 298), persistent non-distressing PLEs (n = 221), and transient non-distressing PLEs (n = 536) groups. Using hierarchical linear models, results indicated youth with distressing PLEs, whether transient or persistent, showed delayed developmental milestones (β = 0.074, 95%CI:0.013,0.134) and altered structural MRI metrics (β = -0.0525, 95%CI:-0.100,-0.005). Importantly, distress interacted with PLEs persistence for the domains of functioning/mental health service utilization (β = 0.079, 95%CI:0.016,0.141), other reported psychopathology (β = 0.101, 95%CI:0.030,0.170), cognition (β = -0.052, 95%CI:0.-0.099,-0.002), and environmental adversity (β = 0.045, 95%CI:0.003,0.0.86; although no family history effects), with the interaction characterized by greatest impairment in the persistent distressing PLEs group. These results have implications for disentangling the importance of distress and persistence for PLEs with regards to impairments, including functional, pathophysiological, and environmental outcomes. These novel longitudinal data underscore that it is often only in the context of distress that persistent PLEs were related to impairments.
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Affiliation(s)
- Nicole R Karcher
- Washington University School of Medicine, Dept. of Psychiatry, St. Louis, MO, USA.
| | - Rachel L Loewy
- University of California, San Francisco, Dept. of Psychiatry, San Francisco, CA, USA
| | - Mark Savill
- University of California, San Francisco, Dept. of Psychiatry, San Francisco, CA, USA
| | | | - Rebekah S Huber
- University of Utah, Dept. of Psychiatry, Salt Lake City, UT, USA
| | - Carolina Makowski
- University of California San Diego, Dept. of Radiology, San Diego, CA, USA
| | - Kenneth J Sher
- University of Missouri, Dept. of Psychological Sciences, Columbia, MO, USA
| | - Deanna M Barch
- Washington University School of Medicine, Dept. of Psychiatry, St. Louis, MO, USA
- Washington University in St. Louis, Dept. of Psychological and Brain Sciences, St. Louis, MO, USA
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11
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Green MJ, O'Hare K, Laurens KR, Tzoumakis S, Dean K, Badcock JC, Harris F, Linscott RJ, Carr VJ. Developmental profiles of schizotypy in the general population: A record linkage study of Australian children aged 11-12 years. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2022; 61:836-858. [PMID: 35229307 PMCID: PMC9541481 DOI: 10.1111/bjc.12363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 02/10/2022] [Indexed: 01/23/2023]
Abstract
Objectives The detection of young people at high risk for psychotic disorders has been somewhat narrowly focused on overt symptom‐based markers that reflect mild reality distortion (e.g., psychotic‐like experiences), or prodromal syndromes that are proximal to psychosis onset. The concept of schizotypy represents a broader framework for investigating risk for schizophrenia (and other disorders) in childhood, before the onset of prodromal or overt symptoms. We sought to detect profiles of risk for psychosis (schizotypy) in a general population sample of 22,137 Australian children aged 11–12 years, and to determine early life risk factors associated with these profiles from data available in linked records (registers). Methods Fifty‐nine self‐reported items were used as indicators of schizotypy across six broad domains; z‐scores for each domain were subjected to latent profile analyses (LPA). A series of multinomial logistic regressions was used to examine the association between resulting profile (class) membership and several childhood and parental risk factors, and the proportion of children with mental disorders among each schizotypy profile was examined. Results The LPA revealed three person‐centred profiles referred to as True Schizotypy (n = 1,323; 6.0%), Introverted Schizotypy (n = 4,473; 20.2%), and Affective Schizotypy (n = 4,261; 19.2%), as well as a group of children showing no risk (n = 12,080; 54.6%). Prior exposure to perinatal and familial adversities including childhood maltreatment, as well as poor early childhood development and academic functioning, was variously associated with all risk groups. There was a higher proportion of childhood mental disorder diagnoses among children in the True Schizotypy group, relative to other profiles. Conclusion Subtle differences in the pattern of exposures and antecedents among schizophrenia liability profiles in childhood may reflect distinct pathogenic pathways to psychotic or other mental illness. Practitioner points Children aged 11–12 years report characteristics of schizotypy which can be classified into three distinct profiles that may represent different pathological processes towards later mental ill‐health. Early life exposure to perinatal and familial adversities including childhood maltreatment, early childhood developmental vulnerability, and poor academic functioning predict membership in all three childhood schizotypy profiles. Latent liability for schizophrenia (and potentially other mental disorders) may be represented by different profiles of functioning observable in childhood.
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Affiliation(s)
- Melissa J Green
- Discipline of Psychiatry and Mental Health, University of New South Wales, Kensington, New South Wales, Australia.,Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Kirstie O'Hare
- Discipline of Psychiatry and Mental Health, University of New South Wales, Kensington, New South Wales, Australia
| | - Kristin R Laurens
- Discipline of Psychiatry and Mental Health, University of New South Wales, Kensington, New South Wales, Australia.,School of Psychology and Counselling, Queensland University of Technology (QUT), Brisbane City, Queensland, Australia
| | - Stacy Tzoumakis
- School of Criminology and Criminal Justice, Griffith University, Gold Coast, Queensland, Australia
| | - Kimberlie Dean
- Discipline of Psychiatry and Mental Health, University of New South Wales, Kensington, New South Wales, Australia.,Justice Health & Forensic Mental Health Network, Sydney, New South Wales, Australia
| | - Johanna C Badcock
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
| | - Felicity Harris
- Discipline of Psychiatry and Mental Health, University of New South Wales, Kensington, New South Wales, Australia
| | | | - Vaughan J Carr
- Discipline of Psychiatry and Mental Health, University of New South Wales, Kensington, New South Wales, Australia.,Neuroscience Research Australia, Sydney, New South Wales, Australia.,Department of Psychiatry, School of Clinical Sciences, Monash University, Melbourne, Australia
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12
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Cortisol Levels in Childhood Associated With Emergence of Attenuated Psychotic Symptoms in Early Adulthood. Biol Psychiatry 2022; 91:226-235. [PMID: 34715990 PMCID: PMC7612877 DOI: 10.1016/j.biopsych.2021.08.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 08/08/2021] [Accepted: 08/11/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND In individuals at clinical high-risk for psychosis, elevated cortisol levels predict subsequent onset of psychotic disorder. However, it is unclear whether cortisol alterations are evident at an earlier clinical stage and promote progression of psychosis expression. This study aimed to address this issue by investigating whether cortisol levels in childhood were associated with the emergence of attenuated psychotic symptoms in early adulthood. In exploratory analyses, we examined whether cortisol and psychosocial stress measures interacted in predicting attenuated psychotic symptoms. METHODS A sample of children (N = 109) enriched for psychosis risk factors were recruited at age 9-12 years and assessed at age 11-14 years (T1) and 17-21 years (T2). Measures of psychopathology, psychosocial stressors, and salivary cortisol were obtained at T1. Attenuated psychotic symptoms were assessed at T2 using the Prodromal Questionnaire. RESULTS Diurnal cortisol (β = 0.915, 95% CI: 0.062-1.769) and daily stressors (β = 0.379, 95% CI: 0.034-0.723) at T1 were independently associated with total Prodromal Questionnaire scores at T2 after accounting for demographic factors and T1 psychopathology. Exploratory analyses indicated a significant interaction between T1 diurnal cortisol and daily stressors (β = 0.743, 95% CI: 0.081-1.405), with the highest predicted T2 total Prodromal Questionnaire scores occurring when both diurnal cortisol and daily stressors were increased. CONCLUSIONS Our findings suggest that daily stressors and elevations in diurnal cortisol in late childhood/early adolescence increases risk for developing attenuated psychotic symptoms. These findings emphasize the importance of assessing environmental and biological risk factors for psychosis during neurodevelopmentally vulnerable time periods.
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13
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Westhoff MLS, Ladwig J, Heck J, Schülke R, Groh A, Deest M, Bleich S, Frieling H, Jahn K. Early Detection and Prevention of Schizophrenic Psychosis-A Review. Brain Sci 2021; 12:11. [PMID: 35053755 PMCID: PMC8774083 DOI: 10.3390/brainsci12010011] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/16/2021] [Accepted: 12/20/2021] [Indexed: 01/04/2023] Open
Abstract
Psychotic disorders often run a chronic course and are associated with a considerable emotional and social impact for patients and their relatives. Therefore, early recognition, combined with the possibility of preventive intervention, is urgently warranted since the duration of untreated psychosis (DUP) significantly determines the further course of the disease. In addition to established diagnostic tools, neurobiological factors in the development of schizophrenic psychoses are increasingly being investigated. It is shown that numerous molecular alterations already exist before the clinical onset of the disease. As schizophrenic psychoses are not elicited by a single mutation in the deoxyribonucleic acid (DNA) sequence, epigenetics likely constitute the missing link between environmental influences and disease development and could potentially serve as a biomarker. The results from transcriptomic and proteomic studies point to a dysregulated immune system, likely evoked by epigenetic alterations. Despite the increasing knowledge of the neurobiological mechanisms involved in the development of psychotic disorders, further research efforts with large population-based study designs are needed to identify suitable biomarkers. In conclusion, a combination of blood examinations, functional imaging techniques, electroencephalography (EEG) investigations and polygenic risk scores should be considered as the basis for predicting how subjects will transition into manifest psychosis.
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Affiliation(s)
- Martin Lennart Schulze Westhoff
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, D-30625 Hannover, Germany; (J.L.); (R.S.); (A.G.); (M.D.); (S.B.); (H.F.); (K.J.)
| | - Johannes Ladwig
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, D-30625 Hannover, Germany; (J.L.); (R.S.); (A.G.); (M.D.); (S.B.); (H.F.); (K.J.)
| | - Johannes Heck
- Institute for Clinical Pharmacology, Hannover Medical School, D-30625 Hannover, Germany;
| | - Rasmus Schülke
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, D-30625 Hannover, Germany; (J.L.); (R.S.); (A.G.); (M.D.); (S.B.); (H.F.); (K.J.)
| | - Adrian Groh
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, D-30625 Hannover, Germany; (J.L.); (R.S.); (A.G.); (M.D.); (S.B.); (H.F.); (K.J.)
| | - Maximilian Deest
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, D-30625 Hannover, Germany; (J.L.); (R.S.); (A.G.); (M.D.); (S.B.); (H.F.); (K.J.)
| | - Stefan Bleich
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, D-30625 Hannover, Germany; (J.L.); (R.S.); (A.G.); (M.D.); (S.B.); (H.F.); (K.J.)
| | - Helge Frieling
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, D-30625 Hannover, Germany; (J.L.); (R.S.); (A.G.); (M.D.); (S.B.); (H.F.); (K.J.)
| | - Kirsten Jahn
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, D-30625 Hannover, Germany; (J.L.); (R.S.); (A.G.); (M.D.); (S.B.); (H.F.); (K.J.)
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14
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Thoughts About Schizophrenia 66 Years After Chlorpromazine. J Clin Psychopharmacol 2021; 40:436-438. [PMID: 32833876 DOI: 10.1097/jcp.0000000000001256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Ellersgaard D, Gregersen M, Spang KS, Christiani C, Burton BK, Hemager N, Søndergaard A, Greve A, Gantriis D, Jepsen JRM, Mors O, Plessen KJ, Thorup AAE, Nordentoft M. Psychotic experiences in seven-year-old children with familial high risk of schizophrenia or bipolar disorder in: The Danish High Risk and Resilience Study - VIA 7; A population-based cohort study. Schizophr Res 2021; 228:510-518. [PMID: 33308959 DOI: 10.1016/j.schres.2020.11.045] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 10/09/2020] [Accepted: 11/23/2020] [Indexed: 01/06/2023]
Abstract
We aimed to examine the prevalence of psychotic experiences (PEs) in children with familial high risk of schizophrenia (FHR-SZ) or bipolar disorder (FHR-BP) and, in exploratory analyses, to examine the possible associations between PEs and mental disorders as well as level of functioning. A cohort of seven-year-old children with FHR-SZ (N = 199), FHR-BP (N = 118) and controls (N = 196) was recruited through Danish nationwide registers. Lifetime PEs were assessed through interviews using the psychosis section of the 'Schedule for Affective Disorders and Schizophrenia for School-Age Children - Present and Lifetime Version' (K-SADS-PL). Lifetime DSM-IV diagnoses were ascertained through K-SADS-PL and the level of functioning of the children through 'Children's Global Assessment Scale'. Both children with FHR-SZ (OR = 2.9, 95% CI = 1.4-6.2, p = 0.005) and FHR-BP (OR = 2.9, 95% CI = 1.3-6.7, p = 0.011) had an increased risk of having experienced "severe" PEs compared with controls. In the overall cohort PEs were associated with any lifetime mental disorder, Attention-Deficit/Hyperactivity Disorder, anxiety disorders and a lower level of functioning. The findings of a higher proportion of high risk children reporting PEs could represent an early manifestation of later more severe psychopathology or simply an unspecific transitory symptom. Future follow-up studies of this cohort will explore the predictive value of the occurrence of PEs at age seven.
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Affiliation(s)
- Ditte Ellersgaard
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Mental Health Services, Capital Region of Denmark, Copenhagen, Gentofte Hospitalsvej 15, 4th floor, DK-2900 Hellerup, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Fuglesangs Allé 26, DK-8210 Aarhus, Denmark
| | - Maja Gregersen
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Mental Health Services, Capital Region of Denmark, Copenhagen, Gentofte Hospitalsvej 15, 4th floor, DK-2900 Hellerup, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Fuglesangs Allé 26, DK-8210 Aarhus, Denmark.
| | - Katrine Soeborg Spang
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Fuglesangs Allé 26, DK-8210 Aarhus, Denmark; Child and Adolescent Mental Health Centre, Mental Health Services, Capital Region of Denmark, Copenhagen, Gentofte Hospitalsvej 3A, 1th floor, DK-2900 Hellerup, Denmark.
| | - Camilla Christiani
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Mental Health Services, Capital Region of Denmark, Copenhagen, Gentofte Hospitalsvej 15, 4th floor, DK-2900 Hellerup, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Fuglesangs Allé 26, DK-8210 Aarhus, Denmark.
| | - Birgitte Klee Burton
- Child and Adolescent Mental Health Centre, Mental Health Services, Capital Region of Denmark, Copenhagen, Gentofte Hospitalsvej 3A, 1th floor, DK-2900 Hellerup, Denmark.
| | - Nicoline Hemager
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Mental Health Services, Capital Region of Denmark, Copenhagen, Gentofte Hospitalsvej 15, 4th floor, DK-2900 Hellerup, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Fuglesangs Allé 26, DK-8210 Aarhus, Denmark.
| | - Anne Søndergaard
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Mental Health Services, Capital Region of Denmark, Copenhagen, Gentofte Hospitalsvej 15, 4th floor, DK-2900 Hellerup, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Fuglesangs Allé 26, DK-8210 Aarhus, Denmark.
| | - Aja Greve
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Fuglesangs Allé 26, DK-8210 Aarhus, Denmark; Psychosis Research Unit, Aarhus University Hospital, Palle Juul-Jensens Boulevard 175, DK-8200 Aarhus, Denmark.
| | - Ditte Gantriis
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Fuglesangs Allé 26, DK-8210 Aarhus, Denmark; Psychosis Research Unit, Aarhus University Hospital, Palle Juul-Jensens Boulevard 175, DK-8200 Aarhus, Denmark.
| | - Jens Richardt Møllegaard Jepsen
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Mental Health Services, Capital Region of Denmark, Copenhagen, Gentofte Hospitalsvej 15, 4th floor, DK-2900 Hellerup, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Fuglesangs Allé 26, DK-8210 Aarhus, Denmark; Child and Adolescent Mental Health Centre, Mental Health Services, Capital Region of Denmark, Copenhagen, Gentofte Hospitalsvej 3A, 1th floor, DK-2900 Hellerup, Denmark.
| | - Ole Mors
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Fuglesangs Allé 26, DK-8210 Aarhus, Denmark; Psychosis Research Unit, Aarhus University Hospital, Palle Juul-Jensens Boulevard 175, DK-8200 Aarhus, Denmark.
| | - Kerstin Jessica Plessen
- Child and Adolescent Mental Health Centre, Mental Health Services, Capital Region of Denmark, Copenhagen, Gentofte Hospitalsvej 3A, 1th floor, DK-2900 Hellerup, Denmark; Division of Child and Adolescent Psychiatry, Department of Psychiatry, Lausanne University Hospital, Avenue d'Echallens 9, CH-1004 Lausanne, Switzerland.
| | - Anne Amalie Elgaard Thorup
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Fuglesangs Allé 26, DK-8210 Aarhus, Denmark; Child and Adolescent Mental Health Centre, Mental Health Services, Capital Region of Denmark, Copenhagen, Gentofte Hospitalsvej 3A, 1th floor, DK-2900 Hellerup, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, DK-2200 Copenhagen N, Denmark.
| | - Merete Nordentoft
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Mental Health Services, Capital Region of Denmark, Copenhagen, Gentofte Hospitalsvej 15, 4th floor, DK-2900 Hellerup, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Fuglesangs Allé 26, DK-8210 Aarhus, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, DK-2200 Copenhagen N, Denmark.
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16
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Ahmedt-Aristizabal D, Fernando T, Denman S, Robinson JE, Sridharan S, Johnston PJ, Laurens KR, Fookes C. Identification of Children at Risk of Schizophrenia via Deep Learning and EEG Responses. IEEE J Biomed Health Inform 2021; 25:69-76. [PMID: 32310808 DOI: 10.1109/jbhi.2020.2984238] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The prospective identification of children likely to develop schizophrenia is a vital tool to support early interventions that can mitigate the risk of progression to clinical psychosis. Electroencephalographic (EEG) patterns from brain activity and deep learning techniques are valuable resources in achieving this identification. We propose automated techniques that can process raw EEG waveforms to identify children who may have an increased risk of schizophrenia compared to typically developing children. We also analyse abnormal features that remain during developmental follow-up over a period of ∼ 4 years in children with a vulnerability to schizophrenia initially assessed when aged 9 to 12 years. EEG data from participants were captured during the recording of a passive auditory oddball paradigm. We undertake a holistic study to identify brain abnormalities, first by exploring traditional machine learning algorithms using classification methods applied to hand-engineered features (event-related potential components). Then, we compare the performance of these methods with end-to-end deep learning techniques applied to raw data. We demonstrate via average cross-validation performance measures that recurrent deep convolutional neural networks can outperform traditional machine learning methods for sequence modeling. We illustrate the intuitive salient information of the model with the location of the most relevant attributes of a post-stimulus window. This baseline identification system in the area of mental illness supports the evidence of developmental and disease effects in a pre-prodromal phase of psychosis. These results reinforce the benefits of deep learning to support psychiatric classification and neuroscientific research more broadly.
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17
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Rosenthal A, Meyer MS, Mayo D, Tully LM, Patel P, Ashby S, Titone M, Carter CS, Niendam TA. Contributions of childhood trauma and atypical development to increased clinical symptoms and poor functioning in recent onset psychosis. Early Interv Psychiatry 2020; 14:755-761. [PMID: 32043308 PMCID: PMC7415665 DOI: 10.1111/eip.12931] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 10/15/2019] [Accepted: 01/27/2020] [Indexed: 11/26/2022]
Abstract
AIM The trauma-psychosis cycle proposes an interactive relationship between impaired developmental and cognitive trajectory, childhood trauma exposure, and increased risk for psychosis. This study explored how childhood trauma (CT) and atypical development (AD) impact clinical course in an early psychosis cohort. METHODS A retrospective chart review of behavioural and clinical research data was conducted with individuals ages 12 to 40 (N = 508; 72.4% males) evaluated by an early psychosis program. RESULTS CT exposure was associated with earlier onset of full threshold psychosis, more hospitalizations, higher ratings of negative symptoms, and increased likelihood of engaging in suicidal behaviour. AD alone was associated with earlier onset of psychosis symptoms, higher ratings of negative symptoms and greater likelihood of engaging in non-suicidal self-injury. The combination of CT and AD was associated with the earliest symptom onset and poorest psychosocial functioning. CONCLUSIONS The findings contribute to our understanding of heterogeneity in the early psychosis population and highlight the specific risk factors that could be targets in treatment.
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Affiliation(s)
- Adi Rosenthal
- Department of Psychiatry & Behavioral Sciences, University of California-Davis, Sacramento, California
| | - Monet S Meyer
- Department of Psychiatry & Behavioral Sciences, University of California-Davis, Sacramento, California
| | - Danessa Mayo
- Department of Psychiatry & Behavioral Sciences, University of California-Davis, Sacramento, California
| | - Laura M Tully
- Department of Psychiatry & Behavioral Sciences, University of California-Davis, Sacramento, California
| | - Pooja Patel
- Department of Psychiatry & Behavioral Sciences, University of California-Davis, Sacramento, California.,Department of Psychology, University of California-Los Angeles, Westwood, California
| | - Stefania Ashby
- Department of Psychiatry & Behavioral Sciences, University of California-Davis, Sacramento, California.,Department of Psychology, University of Oregon, Eugene, Oregon
| | - Madison Titone
- Department of Psychiatry & Behavioral Sciences, University of California-Davis, Sacramento, California.,Department of Psychology, Temple University, Philadelphia, Pennsylvania
| | - Cameron S Carter
- Department of Psychiatry & Behavioral Sciences, University of California-Davis, Sacramento, California.,Center for Neuroscience, University of California-Davis, Davis, California
| | - Tara A Niendam
- Department of Psychiatry & Behavioral Sciences, University of California-Davis, Sacramento, California
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18
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Laurens KR, Murphy J, Dickson H, Roberts RE, Gutteridge TP. Trajectories of Mismatch Negativity and P3a Amplitude Development From Ages 9 to 16 Years in Children With Risk Factors for Schizophrenia. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2020; 5:1085-1094. [PMID: 32981879 DOI: 10.1016/j.bpsc.2020.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 07/17/2020] [Accepted: 07/17/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Mismatch negativity (MMN) and P3a amplitude reductions are robust abnormalities of sensory information processing in schizophrenia, but they are variably present in different profiles of risk (family history vs. clinical high risk) for the disorder. This study aimed to determine whether these abnormalities characterize children presenting replicated risk factors for schizophrenia, using longitudinal assessment over the ages of 9-16 years in children with multiple replicated antecedents of schizophrenia (ASz) and with family history of schizophrenia (FHx), relative to typically developing (TD) peers. METHODS A total of 105 children (52 female) sampled from the community were assessed at ages 9-12 years and approximately 2 and 4 years later. Linear mixed models were fitted to MMN and P3a peak amplitudes and latencies, with intercept and slope estimates from 32 ASz and 28 FHx children compared with those of 45 TD peers. RESULTS In ASz relative to TD children, MMN amplitude initially increased and then prominently decreased during adolescence. Both ASz and FHx children had greater P3a amplitude than TD children at 11 years, which decreased with age, in contrast to P3a amplitude increasing during adolescence in TD youths. MMN abnormalities were specific to ASz children who continued to present symptoms during follow-up. CONCLUSIONS Age-dependent MMN and P3a abnormalities demarcate adolescent development of ASz and FHx from TD children, with auditory change detection abnormalities specific to ASz children with continuing symptoms and attention-orienting abnormalities characterizing both ASz and FHx risk profiles. Follow-up is required to determine whether these abnormalities index vulnerability for schizophrenia or an illness nonspecific developmental delay.
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Affiliation(s)
- Kristin R Laurens
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, Queensland, Australia; Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia; School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia; Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.
| | - Jennifer Murphy
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia; Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London, United Kingdom
| | - Hannah Dickson
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Ruth E Roberts
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; Division of Psychology and Language Sciences, University College London, London, United Kingdom; Kantor Centre of Excellence, Anna Freud National Centre for Children and Families, London, United Kingdom
| | - Tiffany P Gutteridge
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, Queensland, Australia; Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
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19
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Dickson H, Hedges EP, Ma SY, Cullen AE, MacCabe JH, Kempton MJ, Downs J, Laurens KR. Academic achievement and schizophrenia: a systematic meta-analysis. Psychol Med 2020; 50:1949-1965. [PMID: 32684198 DOI: 10.1017/s0033291720002354] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Cognitive impairments in childhood are associated with increased risk of schizophrenia in later life, but the extent to which poor academic achievement is associated with the disorder is unclear. METHODS Major databases were searched for articles published in English up to 31 December 2019. We conducted random-effects meta-analyses to: (1) compare general academic and mathematics achievement in youth who later developed schizophrenia and those who did not; (2) to examine the association between education level achieved and adult-onset schizophrenia; and, (3) compare general academic achievement in youth at-risk for schizophrenia and typically developing peers. Meta-regression models examined the effects of type of academic assessment, educational system, age at assessment, measurement of educational level attained, school leaving age, and study quality on academic achievement and education level among individuals with schizophrenia. RESULTS Meta-analyses, comprising data of over four million individuals, found that: (1) by age 16 years, those who later developed schizophrenia had poorer general academic (Cohen's d = -0.29, p ⩽ 0.0001) and mathematics achievement (d = -0.23, p = 0.01) than those who did not; (2) individuals with schizophrenia were less likely to enter higher education (odds ratio = 0.49, p ⩽ 0.0001); and, (3) youth reporting psychotic-like experiences and youth with a family history of schizophrenia had lower general academic achievement (d = -0.54, p ⩽ 0.0001; d = -0.39, p ⩽ 0.0001, respectively). Meta-regression analyses determined no effect modifiers. DISCUSSION Despite significant heterogeneity across studies, various routinely collected indices of academic achievement can identify premorbid cognitive dysfunction among individuals who are vulnerable for schizophrenia, potentially aiding the early identification of risk in the population.
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Affiliation(s)
- Hannah Dickson
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Emily P Hedges
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Shin Y Ma
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Alexis E Cullen
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - James H MacCabe
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Matthew J Kempton
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Johnny Downs
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Kristin R Laurens
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Queensland University of Technology (QUT), School of Psychology and Counselling, and Institute of Health and Biomedical Innovation, Brisbane, QLD, Australia
- School of Psychiatry, University of New South Wales, NSW, Australia
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20
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Gutteridge TP, Lang CP, Turner AM, Jacobs BW, Laurens KR. Criterion validity of the Psychotic-Like Experiences Questionnaire for Children (PLEQ-C). Schizophr Res 2020; 220:78-84. [PMID: 32278538 DOI: 10.1016/j.schres.2020.03.067] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 01/09/2020] [Accepted: 03/29/2020] [Indexed: 12/25/2022]
Abstract
Psychotic-like experiences (PLEs) are perceptual and thought disturbances that, although common among children, increase risk for future psychopathology, particularly if persistent. Clinical interviews are too time-consuming and costly to administer at a population level, but the criterion validity of a brief questionnaire for screening community samples of children as young as 9 years for PLEs has not been established. This study aimed to test the criterion (concurrent and predictive) validity of the Psychotic-Like Experiences Questionnaire for Children (PLEQ-C). The PLEQ-C (9-item self- and 10-item parent-report versions) was administered to 139 children aged 9-12 years and their caregivers recruited from Greater London, UK. Children additionally completed a diagnostic interview assessing hallucinations and delusions and three further PLEQ-C assessments at approximately 24-month intervals. Concordance of child- and caregiver-reports of PLEs on questionnaire (PLE-Q) was low. Self-reports of any PLE-Q demonstrated good sensitivity (73.3%), specificity (78.5%), positive and negative predictive values (PPV: 72.1%; NPV: 79.5%) for any PLE determined by interview (PLE-I), whereas caregiver-reports of any PLE-Q performed poorly (sensitivity 51.7%, specificity 78.5%, PPV 64.6%, NPV 68.1%). Multinomial regression analyses indicated that children reporting any PLE-Q at screening were at significantly increased risk of reporting PLEs on multiple assessments during adolescence relative to no PLEs, closely replicating the pattern and magnitude of effects (large-to-very large) obtained for children with any PLE-I. The PLEQ-C offers a valid, brief, feasible, and cost-effective means of community screening to identify children who present with PLEs and could be assessed with clinical interview.
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Affiliation(s)
- Tiffany P Gutteridge
- School of Psychology and Counselling, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Cathryne P Lang
- School of Psychology, Australian Catholic University, Brisbane, QLD, Australia; Sunshine Coast Mind and Neuroscience - Thompson Institute, University of the Sunshine Coast, Birtinya, QLD, Australia
| | - Alison M Turner
- School of Psychology, Australian Catholic University, Brisbane, QLD, Australia
| | - Brian W Jacobs
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK; Child and Adolescent Mental Health Services, South London and Maudsley National Health Service Foundation Trust, London, UK
| | - Kristin R Laurens
- School of Psychology and Counselling, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia; Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.
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21
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Seiler N, Nguyen T, Yung A, O'Donoghue B. Terminology and assessment tools of psychosis: A systematic narrative review. Psychiatry Clin Neurosci 2020; 74:226-246. [PMID: 31846133 DOI: 10.1111/pcn.12966] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 12/05/2019] [Indexed: 12/20/2022]
Abstract
AIM Phenomena within the psychosis continuum that varies in frequency/duration/intensity have been increasingly identified. Different terms describe these phenomena, however there is no standardization within the terminology. This review evaluated the definitions and assessment tools of seven terms - (i) 'psychotic experiences'; (ii) 'psychotic-like experiences'; (iii) 'psychotic-like symptoms'; (iv) 'attenuated psychotic symptoms'; (v) 'prodromal psychotic symptoms'; (vi) 'psychotic symptomatology'; and (vii) 'psychotic symptoms'. METHODS EMBASE, MEDLINE, and CINAHL were searched during February-March 2019. Inclusion criteria included 1989-2019, full text, human, and English. Papers with no explicit definition or assessment tool, duplicates, conference abstracts, systematic reviews, meta-analyses, or no access were excluded. RESULTS A total of 2238 papers were identified and of these, 627 were included. Definitions and assessment tools varied, but some trends were found. Psychotic experiences and psychotic-like experiences were transient and mild, found in the general population and those at-risk. Psychotic-like symptoms were subthreshold and among at-risk populations and non-psychotic mental disorders. Attenuated psychotic symptoms were subthreshold but associated with distress, risk, and help-seeking. Prodromal psychotic symptoms referred to the prodrome of psychotic disorders. Psychotic symptomatology included delusions and hallucinations within psychotic disorders. Psychotic symptoms was the broadest term, encompassing a range of populations but most commonly involving hallucinations, delusions, thought disorder, and disorganization. DISCUSSION A model for conceptualizing the required terms is proposed and future directions needed to advance this field of research are discussed.
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Affiliation(s)
- Natalie Seiler
- Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne, Australia.,The University of Melbourne, Parkville, Melbourne, Australia.,Orygen Youth Health, Parkville, Melbourne, Australia
| | - Tony Nguyen
- Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne, Australia.,The University of Melbourne, Parkville, Melbourne, Australia.,Orygen Youth Health, Parkville, Melbourne, Australia
| | - Alison Yung
- Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne, Australia.,Orygen Youth Health, Parkville, Melbourne, Australia
| | - Brian O'Donoghue
- Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne, Australia.,Orygen Youth Health, Parkville, Melbourne, Australia
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22
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Colizzi M, Lasalvia A, Ruggeri M. Prevention and early intervention in youth mental health: is it time for a multidisciplinary and trans-diagnostic model for care? Int J Ment Health Syst 2020; 14:23. [PMID: 32226481 PMCID: PMC7092613 DOI: 10.1186/s13033-020-00356-9] [Citation(s) in RCA: 126] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 03/16/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Similar to other health care sectors, mental health has moved towards the secondary prevention, with the effort to detect and treat mental disorders as early as possible. However, converging evidence sheds new light on the potential of primary preventive and promotion strategies for mental health of young people. We aimed to reappraise such evidence. METHODS We reviewed the current state of knowledge on delivering promotion and preventive interventions addressing youth mental health. RESULTS Half of all mental disorders start by 14 years and are usually preceded by non-specific psychosocial disturbances potentially evolving in any major mental disorder and accounting for 45% of the global burden of disease across the 0-25 age span. While some action has been taken to promote the implementation of services dedicated to young people, mental health needs during this critical period are still largely unmet. This urges redesigning preventive strategies in a youth-focused multidisciplinary and trans-diagnostic framework which might early modify possible psychopathological trajectories. CONCLUSIONS Evidence suggests that it would be unrealistic to consider promotion and prevention in mental health responsibility of mental health professionals alone. Integrated and multidisciplinary services are needed to increase the range of possible interventions and limit the risk of poor long-term outcome, with also potential benefits in terms of healthcare system costs. However, mental health professionals have the scientific, ethical, and moral responsibility to indicate the direction to all social, political, and other health care bodies involved in the process of meeting mental health needs during youth years.
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Affiliation(s)
- Marco Colizzi
- 1Section of Psychiatry, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy
- 2Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF UK
| | - Antonio Lasalvia
- 1Section of Psychiatry, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy
| | - Mirella Ruggeri
- 1Section of Psychiatry, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy
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23
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Adolescent trajectories of fine motor and coordination skills and risk for schizophrenia. Schizophr Res 2020; 215:263-269. [PMID: 31672386 DOI: 10.1016/j.schres.2019.10.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 08/09/2019] [Accepted: 10/03/2019] [Indexed: 12/31/2022]
Abstract
Premorbid motor dysfunction is one of the earliest of developmental antecedents identified among individuals who develop schizophrenia in adulthood. However, among individuals with schizophrenia, premorbid motor dysfunction is not apparent at all stages of childhood development and may reduce with increasing age. Currently, little is known about the trajectories of motor development during adolescence among youth at-risk for the disorder. One hundred and one participants were assessed repeatedly, at approximately 24-month intervals (time 1, aged 9-12 years; time 2, 11-14 years; and time 3, 13-16 years), on the Purdue Pegboard assessment, comprising four subtests: Dominant Hand (DH), Non-Dominant Hand (NDH), Both Hands (BH), and Assembly. Fine motor and coordination skills development between ages 9-16 years was compared between youth characterised by a triad of developmental antecedents of schizophrenia (ASz, N = 32); youth with at least one affected relative with schizophrenia/schizoaffective disorder (FHx; N = 26); and typically developing youth without antecedents or family history (TD, N = 43). Longitudinal mixed models for repeated measures indicated significant motor skills improvements with age in TD youth on the Assembly subtest only. Relative to TD youth, we found evidence for developmental deficits (i.e., dysfunction that emerged early and remained stable) among ASz youth on DH and BH subtests, and among FHx youth on the Assembly subtest. ASz youth were characterised by a developmental delay on the Assembly subtest (i.e., initial performance decrement in middle childhood that caught up with peers' performance during adolescence). These divergences from normative motor development may reflect differences in structural and functional neural correlates.
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24
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Oexle N, Ribeiro W, Fisher HL, Gronholm PC, Laurens KR, Pan P, Owens S, Romeo R, Rüsch N, Evans-Lacko S. Childhood bullying victimization, self-labelling, and help-seeking for mental health problems. Soc Psychiatry Psychiatr Epidemiol 2020; 55:81-88. [PMID: 31324960 DOI: 10.1007/s00127-019-01743-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 06/24/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Previous research found sustained high levels of mental health service use among adults who experienced bullying victimization during childhood. This could be due to increased psychopathology among this group, but other factors, such as self-perception as having a mental health problem, might contribute to increased service use. Additionally, the relationship between informal help-seeking for mental health problems and bullying victimization is incompletely understood. METHODS The present study examined associations between the frequency of bullying victimization and both formal service use and informal help-seeking for mental health problems independent from psychopathology. Data on bullying victimization, service use, informal help-seeking for mental health problems, psychopathology, and self-labelling as a person with mental illness were collected among 422 young people aged 13-22 years. RESULTS In logistic regression models, controlling for past and current psychopathology and using no bullying victimization as the reference category, we identified a greater likelihood of mental health service use among persons who experienced frequent bullying victimization, as well as a greater likelihood of seeking informal help among persons who experienced occasional victimization. Increased self-identification as a person with mental illness completely mediated the positive association between frequent bullying victimization and mental health service use. CONCLUSIONS Our findings suggest that services to support persons who experienced frequent bullying victimization should focus on improving empowerment and self-perception. Additionally, there might be unserved need for formal support among those who experienced occasional bullying victimization.
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Affiliation(s)
- Nathalie Oexle
- Department of Psychiatry II, Ulm University and BKH Günzburg, Ulm, Germany
| | - Wagner Ribeiro
- Personal Social Services Research Unit, London School of Economics and Political Science, Houghton Street, London, WC2A2AE, UK
| | - Helen L Fisher
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Petra C Gronholm
- Personal Social Services Research Unit, London School of Economics and Political Science, Houghton Street, London, WC2A2AE, UK.,Health Service and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Kristin R Laurens
- School of Psychology, Australian Catholic University, Brisbane, Australia.,School of Psychiatry, University of New South Wales, Sydney, Australia.,Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Pedro Pan
- Interdisciplinary Laboratory of Clinical Neurosciences (LiNC), Department of Psychiatry, Universidade Federal de Sâo Paulo, São Paulo, Brazil
| | - Shanise Owens
- Office of Minority Health, Office of the Secretary, US Department of Health and Human Services, Rockville, MD, USA
| | - Renee Romeo
- Health Service and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Nicolas Rüsch
- Department of Psychiatry II, Ulm University and BKH Günzburg, Ulm, Germany
| | - Sara Evans-Lacko
- Personal Social Services Research Unit, London School of Economics and Political Science, Houghton Street, London, WC2A2AE, UK. .,Health Service and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.
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25
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Pituitary volume in individuals at elevated risk for psychosis: A systematic review and meta-analysis. Schizophr Res 2019; 213:23-31. [PMID: 30600112 DOI: 10.1016/j.schres.2018.12.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 12/13/2018] [Accepted: 12/16/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Pituitary volume (PV) abnormalities, representing one of several markers of hypothalamic-pituitary-adrenal (HPA) axis dysregulation, have been observed in psychosis, with variable patterns across illness stages. Typically, enlargements characterise first-episode patients, with reductions observed in those with chronic illness relative to healthy controls. Findings in high-risk populations have been inconsistent, highlighting the need for an updated review of the evidence. METHODS We searched PubMed, PsycINFO, and EMBASE for studies examining PV in high-risk [clinical high-risk (CHR), family history of psychosis (FHx), schizotypal personality disorder (SPD), and psychotic-experiences (PEs)] and healthy individuals. Random effects models were used to examine group differences in PV (Hedges g) with stratified analyses and meta-regression employed to investigate the effect of high-risk category, transition status, age, sex, and antipsychotic medication. RESULTS Ten studies, yielding 11 effect sizes, were eligible for inclusion. Overall, high-risk individuals had significantly larger PV relative to healthy controls (g = 0.16 [95% CI: 0.01 to 0.32] p = 0.04), despite showing a reduction in whole brain volume (g = -0.17, [95% CI. -0.30 to -0.03] p = 0.020). Individual sub-group analyses for CHR and FHx groups showed no significant differences relative to controls; however, larger PV increases characterised those who later transitioned to psychosis (g = 0.55, [95% CI. 0.06 to 1.04] p = 0.028). Larger effect sizes were positively associated with the proportion of high-risk individuals receiving antipsychotic medication. CONCLUSIONS PV enlargements characterise high-risk individuals and are more pronounced among those who later develop psychosis. We provide recommendations for future studies.
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26
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Laurens KR, Tzoumakis S, Dean K, Harris F, Carr VJ, Green MJ. Population profiles of child‐reported psychotic‐like experiences and their differential association with other psychopathologies. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2019; 59:22-38. [PMID: 31328800 DOI: 10.1111/bjc.12230] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 06/17/2019] [Indexed: 01/12/2023]
Affiliation(s)
- Kristin R. Laurens
- School of Psychology and Counselling, and Institute of Health and Biomedical Innovation Queensland University of Technology Brisbane Queensland Australia
- School of Psychiatry University of New South Wales Sydney New South Wales Australia
| | - Stacy Tzoumakis
- School of Social Sciences University of New South Wales Sydney New South Wales Australia
| | - Kimberlie Dean
- School of Psychiatry University of New South Wales Sydney New South Wales Australia
- Justice Health & Forensic Mental Health Network Matraville New South Wales Australia
| | - Felicity Harris
- School of Psychiatry University of New South Wales Sydney New South Wales Australia
| | - Vaughan J. Carr
- School of Psychiatry University of New South Wales Sydney New South Wales Australia
- School of Social Sciences University of New South Wales Sydney New South Wales Australia
- Department of Psychiatry Monash University Melbourne Victoria Australia
| | - Melissa J. Green
- School of Psychiatry University of New South Wales Sydney New South Wales Australia
- Neuroscience Research Australia Sydney New South Wales Australia
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27
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Kalman JL, Bresnahan M, Schulze TG, Susser E. Predictors of persisting psychotic like experiences in children and adolescents: A scoping review. Schizophr Res 2019; 209:32-39. [PMID: 31109737 DOI: 10.1016/j.schres.2019.05.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 02/22/2019] [Accepted: 05/05/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Subclinical psychotic experiences (PLEs) are among the frequently reported mental health problems in children/adolescents. PLEs identified in cross sectional studies of children/adolescents are associated with current and future mental health problems. These associations are stronger for PLEs that persist over time. Hence, it could be useful to examine which children/adolescents with PLEs at a first assessment (baseline) are more likely to have PLEs at subsequent assessments. METHODS We conducted a scoping review of studies that examined whether characteristics of children/adolescents (≤18 years) with PLEs at baseline predict whether PLEs are likely to be persistent or remittent at subsequent assessments. We included studies published between January 2002 and December 2017, conducted on general child/adolescent populations of ≥300 individuals, that provided data on PLEs for at least 2 time points, had available follow-up data for ≥50% of those assessed for PLEs at baseline and targeted for follow-up examination, and reported the differences between individuals with PLEs that persisted or remitted during the study period. RESULTS Six studies met our criteria. Each of them investigated a wide range of baseline characteristics but no predictor of persistence was replicated. CONCLUSIONS Our knowledge about which children/adolescents with PLEs at an initial assessment are likely to have persistent PLEs at subsequent assessments is sparse. A handful of predictors of persistent PLEs have been investigated so far, and none replicated. A better understanding of these predictors would be an important complement to investigations examining the evolution of PLEs and of mental health problems in children/adolescents.
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Affiliation(s)
- Janos L Kalman
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany; Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Munich, Germany; International Max Planck Research School for Translational Psychiatry (IMPRS-TP), Munich, Germany.
| | - Michaeline Bresnahan
- Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Thomas G Schulze
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany; Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, United States; Department of Psychiatry and Psychotherapy, University Medical Center, Georg-August University Göttingen, Göttingen, Germany; Department of Genetic Epidemiology in Psychiatry, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
| | - Ezra Susser
- Mailman School of Public Health, Columbia University, New York, NY, United States; New York State Psychiatric Institute, New York, New York, United States
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Silverman M, Frankovich J, Nguyen E, Leibold C, Yoon J, Mark Freeman G, Karpel H, Thienemann M. Psychotic symptoms in youth with Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) may reflect syndrome severity and heterogeneity. J Psychiatr Res 2019; 110:93-102. [PMID: 30605785 DOI: 10.1016/j.jpsychires.2018.11.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 11/04/2018] [Accepted: 11/13/2018] [Indexed: 12/27/2022]
Abstract
OBJECTIVE In the clinical syndrome Pediatric Acute-onset Neuropsychiatric Syndrome (PANS), obsessive compulsive disorder (OCD) and/or food refusal symptoms have an abrupt-onset (over 48 h) coupled with at least two other specified neuropsychiatric symptoms. We aimed to characterize in detail for the first time, psychotic symptoms experienced by children with PANS as well as the impact of psychotic symptoms on disease severity and course of illness. We inform about the diagnosis of the clinical description: PANS and hope to improve evaluation, treatment, diagnostic validity and future investigation. METHODS Retrospective review of 143 consecutive PANS clinic patient charts meeting inclusion criteria. The Caregiver Burden Inventory, Global Impairment Score, and Children's Global Assessment Scale were used to assess impairment. RESULTS Visual and auditory hallucinations were each experienced by 36%, of which most (83%) were transient and complex (non-threatening voices or figures). 6.3% and 5.5% of patients experienced delusions and thought disorganization respectively. Those with psychotic symptoms showed statistically significant differences in disease impairment and caregiver burden. There were no differences in time to treatment access or length of illness. CONCLUSIONS Over 1/3 of children with PANS experienced transient hallucinations. They were more impaired than those without psychotic symptoms, but showed no differences in disease progression. This difference may point toward heterogeneity in PANS. When evaluating children with acute psychotic symptoms, clinicians should screen for abrupt-onset of a symptom cluster including OCD and/or food refusal, with neuropsychiatric symptoms (enuresis, handwriting changes, tics, hyperactivity, sleep disorder) before initiating treatment.
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Affiliation(s)
- Melissa Silverman
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States; Stanford Pediatric Acute-onset Neuropsychiatric Sydrome Clinic and Research Program at Lucile Packard Children's Hospital, Stanford University, Stanford, CA, United States.
| | - Jennifer Frankovich
- Pediatric Division of Allergy, Immunology, and Rheumatology, Stanford University, Stanford, CA, United States; Stanford Pediatric Acute-onset Neuropsychiatric Sydrome Clinic and Research Program at Lucile Packard Children's Hospital, Stanford University, Stanford, CA, United States
| | - Emily Nguyen
- Stanford Pediatric Acute-onset Neuropsychiatric Sydrome Clinic and Research Program at Lucile Packard Children's Hospital, Stanford University, Stanford, CA, United States
| | - Collin Leibold
- Pediatric Division of Allergy, Immunology, and Rheumatology, Stanford University, Stanford, CA, United States; Stanford Pediatric Acute-onset Neuropsychiatric Sydrome Clinic and Research Program at Lucile Packard Children's Hospital, Stanford University, Stanford, CA, United States
| | - Jong Yoon
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States; VA Palo Alto Health Care System, 3801 Miranda Ave., Building 4, 2nd Floor, Palo Alto, CA, 94304, United States
| | - G Mark Freeman
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States
| | - Hannah Karpel
- Pediatric Division of Allergy, Immunology, and Rheumatology, Stanford University, Stanford, CA, United States; Stanford Pediatric Acute-onset Neuropsychiatric Sydrome Clinic and Research Program at Lucile Packard Children's Hospital, Stanford University, Stanford, CA, United States
| | - Margo Thienemann
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States; Stanford Pediatric Acute-onset Neuropsychiatric Sydrome Clinic and Research Program at Lucile Packard Children's Hospital, Stanford University, Stanford, CA, United States
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29
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Evans-Lacko S, Stolzenburg S, Gronholm PC, Ribeiro W, York-Smith M, Schomerus G. Psychometric validation of the self-identification of having a mental illness (SELF-I) scale and the relationship with stigma and help-seeking among young people. Soc Psychiatry Psychiatr Epidemiol 2019; 54:59-67. [PMID: 30284599 PMCID: PMC6336739 DOI: 10.1007/s00127-018-1602-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 09/18/2018] [Indexed: 11/27/2022]
Abstract
PURPOSE Self-identification of having a mental illness has been shown to be an important factor underpinning help-seeking behaviour and may mediate the relationship between personal stigma and mental health service use. This study validates a new scale for the self-identification of having a mental illness among a non-clinical, community cohort of young people in the UK. METHODS Following consultation with a group of young person experts with experience of mental health problems, we evaluated the psychometric properties of the self-identification of mental illness scale (SELF-I) among 423 young people aged 13-24 years who are part of an ongoing prospective community cohort. We performed test retest reliability among a subset of 53 participants. Psychometric validation for the scale used measures of Cronbach's alpha and Pearson's correlation coefficient. Item performance was assessed along and in relation with each covariate. RESULTS The SELF-I demonstrated robust psychometric properties including high test-retest reliability (0.95) and good internal consistency (0.87 as determined by the Cronbach's alpha). The inter-total correlations for each item, which ranged from 0.62 to 0.74, supported keeping all items in the scale. Reporting greater psychiatric symptomatology via the SDQ (β: 0.82 95% confidence interval 0.40, 1.23), psychotic-like experiences (β: 0.37 95% confidence interval 0.14, 0.59), and use of mental health services (β: 0.92 95% confidence interval 0.71, 1.13) were associated with a greater self-perception as having a mental illness (p < 0.05), providing evidence of convergent validity. As expected, we found that less intended stigmatising behaviour was associated with greater self-perceptions of having a mental illness (B: 0.18, 95% CI 0.07, 0.28). CONCLUSIONS The SELF-I scale provides a method to gather insight into how young people, who may not identify as service users, perceive their own mental state and potential risk for developing a mental illness. This can be important for understanding perceived need for help and likelihood of using services among those with mental health problems.
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Affiliation(s)
- Sara Evans-Lacko
- Personal Social Services Research Unit, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK.
| | - Susanne Stolzenburg
- Department of Psychiatry, Universitätsmedizin Greifswald, Ellernholzstr. 2, 17475, Greifswald, Germany
| | - Petra C Gronholm
- Personal Social Services Research Unit, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK
| | - Wagner Ribeiro
- Personal Social Services Research Unit, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK
| | - Marianna York-Smith
- Personal Social Services Research Unit, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK
| | - Georg Schomerus
- Department of Psychiatry, Universitätsmedizin Greifswald, Ellernholzstr. 2, 17475, Greifswald, Germany
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30
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Okkenhaug A, Tanem T, Myklebust TÅ, Gjervan B, Johansen A. Self-reported premorbid health in 15 individuals who later developed schizophrenia compared with healthy controls: Prospective data from the Young-HUNT1 Survey (The HUNT Study). ACTA ACUST UNITED AC 2018. [DOI: 10.15714/scandpsychol.5.e8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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31
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Dickson H, Cullen AE, Jones R, Reichenberg A, Roberts RE, Hodgins S, Morris RG, Laurens KR. Trajectories of cognitive development during adolescence among youth at-risk for schizophrenia. J Child Psychol Psychiatry 2018; 59:1215-1224. [PMID: 29683193 DOI: 10.1111/jcpp.12912] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/13/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Among adults with schizophrenia, evidence suggests that premorbid deficits in different cognitive domains follow distinct developmental courses during childhood and adolescence. The aim of this study was to delineate trajectories of adolescent cognitive functions prospectively among different groups of youth at-risk for schizophrenia, relative to their typically developing (TD) peers. METHOD Using linear mixed models adjusted for sex, ethnicity, parental occupation and practice effects, cognitive development between ages 9 and 16 years was compared for youth characterised by a triad of well-replicated developmental antecedents of schizophrenia (ASz; N = 32) and youth with a least one affected relative with schizophrenia or schizoaffective disorder (FHx; N = 29), relative to TD youth (N = 45). Participants completed measures of IQ, scholastic achievement, memory and executive function at three time-points, separated by approximately 24-month intervals. RESULTS Compared to TD youth, both ASz and FHx youth displayed stable developmental deficits in verbal working memory and inhibition/switching executive functions. ASz youth additionally presented with stable deficits in measures of vocabulary (IQ), word reading, numerical operations, and category fluency executive function, and a slower rate of growth (developmental lag) on spelling from 9 to 16 years than TD peers. Conversely, faster rates of growth relative to TD peers (developmental delay) were observed on visual and verbal memory, and on category fluency executive function (ASz youth only) and on matrix reasoning (IQ) and word reading (FHx youth only). CONCLUSIONS These differential patterns of deviation from normative adolescent cognitive development among at-risk youth imply potential for cognitive rehabilitation targeting of specific cognitive deficits at different developmental phases.
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Affiliation(s)
- Hannah Dickson
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Alexis E Cullen
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Rebecca Jones
- Division of Psychiatry, University College London, London, UK
| | - Abraham Reichenberg
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,Department of Psychiatry and Preventive Medicine, The Freidman Brain Institute, Ichan School of Medicine at Mount Sinai, New York, NY, USA
| | - Ruth E Roberts
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Sheilagh Hodgins
- Département de Psychiatrie, Université de Montréal, Montreal, QC, Canada
| | - Robin G Morris
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, UK
| | - Kristin R Laurens
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,School of Psychology, Australian Catholic University, Brisbane, QLD, Australia.,School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
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32
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Karcher NR, Barch DM, Avenevoli S, Savill M, Huber RS, Simon TJ, Leckliter IN, Sher KJ, Loewy RL. Assessment of the Prodromal Questionnaire-Brief Child Version for Measurement of Self-reported Psychoticlike Experiences in Childhood. JAMA Psychiatry 2018; 75:853-861. [PMID: 29874361 PMCID: PMC6143092 DOI: 10.1001/jamapsychiatry.2018.1334] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
IMPORTANCE Childhood psychoticlike experiences (PLEs) are associated with greater odds of a diagnosis of a psychotic disorder during adulthood. However, no known, well-validated self-report tools have been designed to measure childhood PLEs. OBJECTIVE To examine the construct validity and psychometric properties of a measure of PLEs, the Prodromal Questionnaire-Brief Child Version (PQ-BC). DESIGN, SETTING, AND PARTICIPANTS This validation study used data from the first wave of the Adolescent Brain and Cognitive Development (ABCD) Study, a prospective longitudinal study aimed at assessing risk factors associated with adverse physical and mental health outcomes from ages 9 to 10 years into late adolescence and early adulthood. The population-based sample of 3984 children within the ABCD data set was recruited from 20 research sites across the United States. Data for this study were collected from June 1, 2016, through August 31, 2017. MAIN OUTCOMES AND MEASURES The PQ-BC Total and Distress scores were analyzed for measurement invariance across race/ethnicity and sex, their associations with measures of PLEs, and their associations with known correlates of PLEs, including internalizing and externalizing symptoms, neuropsychological test performance, and developmental milestones. RESULTS The study analyses included 3984 participants (1885 girls [47.3%] and 2099 boys [52.7%]; mean [SE] age, 10.0 [0.01] years). The results demonstrated measurement invariance across race/ethnicity and sex. A family history of psychotic disorder was associated with higher mean (SE) PQ-BC Total (3.883 [0.352]; β = 0.061; 95% CI, 0.027-0.094) and Distress (10.210 [1.043]; β = 0.051; 95% CI, 0.018-0.084) scores, whereas a family history of depression or mania was not. Higher PQ-BC scores were associated with higher rates of child-rated internalizing symptoms (Total score: β range, 0.218 [95% CI, 0.189-0.246] to 0.273 [95% CI, 0.245-0.301]; Distress score: β range, 0.248 [95% CI, 0.220-0.277] to 0.310 [95% CI, 0.281-0.338]), neuropsychological test performance deficits such as working memory (Total score: β = -0.042 [95% CI, -0.077 to -0.008]; Distress score: β = -0.051 [95% CI, -0.086 to -0.017]), and motor and speech developmental milestone delays (Total score: β = 0.057 [95% CI, 0.026-0.086] for motor; β = 0.042 [95% CI, 0.010-0.073] for speech; Distress score: β = 0.048 [95% CI, 0.017-0.079] for motor; β = 0.049 [95% CI, 0.018-0.081] for speech). CONCLUSIONS AND RELEVANCE These results provide support for the construct validity and demonstrate adequate psychometric properties of a self-report instrument designed to measure childhood PLEs, providing evidence that the PQ-BC may be a useful measure of early risk for psychotic disorders. Furthermore, these data suggest that PLEs at school age are associated with many of the same familial, cognitive, and emotional factors associated with psychotic symptoms in older populations, consistent with the dimensionality of psychosis across the lifespan.
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Affiliation(s)
- Nicole R. Karcher
- Department of Psychiatry, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Deanna M. Barch
- Department of Psychiatry, Washington University School of Medicine in St Louis, St Louis, Missouri
| | | | - Mark Savill
- Department of Psychiatry, University of California, San Francisco
| | | | - Tony J. Simon
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento
| | - Ingrid N. Leckliter
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento
| | | | - Rachel L. Loewy
- Department of Psychiatry, University of California, San Francisco
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Jolley S, Kuipers E, Stewart C, Browning S, Bracegirdle K, Basit N, Gin K, Hirsch C, Corrigall R, Banerjea P, Turley G, Stahl D, Laurens KR. The Coping with Unusual Experiences for Children Study (CUES): A pilot randomized controlled evaluation of the acceptability and potential clinical utility of a cognitive behavioural intervention package for young people aged 8-14 years with unusual experiences and emotional symptoms. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2018. [PMID: 29527754 DOI: 10.1111/bjc.12176] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES Health care guidelines recommend psychological interventions for childhood unusual experiences that are associated with distress or adverse functional impact (UEDs), based on adult, rather than child-specific, evidence. We report the first randomized controlled evaluation of the acceptability and potential clinical utility of cognitive behavioural therapy for childhood UEDs (CBT-UED). DESIGN Pilot randomized controlled trial. METHODS Participants aged 8-14 years were recruited from referrals to community services for children with emotional/behavioural problems and screened for self-reported UEDs. RESULTS Of around 1,000 referrals over 36 months, 304 (30%) were identified to the research team, 174 (57%) were successfully contacted, 110 (63%) consented to screening, 96 (87%) attended a screening assessment, and 51 (53%) reported UEDs. Forty-nine (96%) consented to randomization to either CBT-UED (9-12 weekly sessions of 40-50 min, adjunctive to usual care, n = 24) or treatment-as-usual/waitlist control (TAU/WL, n = 25). Childhood internalizing emotional symptoms (e.g., feeling 'nervous'/'scared'/'tearful'/'worried'/'sick'; proposed primary outcome), UEDs, depression, anxiety, and childhood psychopathology (secondary outcomes) were measured at baseline, at 12 weeks, and, where therapy was ongoing but incomplete (<12 sessions) at 12 weeks, at end-of-treatment (EOT). Twenty-two CBT-UED participants (92%) attended ≥5 sessions. Forty-four participants (90%) completed 12-week assessments (CBT-UED, n = 21/24, 88%; TAU/WL, n = 23/25, 92%). Preliminary findings were encouraging for emotional symptoms and UEDs, but otherwise mixed. CONCLUSIONS Retention, screening, and consent rates were as anticipated; recruitment took longer than planned. Trial procedures were acceptable to young people, their families, and clinicians. Therapy exceeded 12 weeks, but was well-received, with no serious adverse events attributed to participation. Further evaluation is needed. PRACTITIONER POINTS Around half of 8- to 14-year-olds in Child and Adolescent Mental Health Services reported distressing unusual experiences. An age-adapted cognitive behavioural intervention appears feasible, and safe to deliver, with the potential to augment standard care. This is a pilot study, and further evaluation is needed. Longer term outcomes should be a focus of future evaluation.
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Affiliation(s)
- Suzanne Jolley
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, UK
| | - Elizabeth Kuipers
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, UK.,National Institute for Health Research Mental Health Biomedical Research Centre at the South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Catherine Stewart
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, UK.,South London and Maudsley NHS Foundation Trust, UK
| | | | | | - Nedah Basit
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, UK
| | | | - Colette Hirsch
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, UK.,National Institute for Health Research Mental Health Biomedical Research Centre at the South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | | | | | - Grainne Turley
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, UK
| | - Daniel Stahl
- National Institute for Health Research Mental Health Biomedical Research Centre at the South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK.,Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Kristin R Laurens
- School of Psychology, Faculty of Health Sciences, Australian Catholic University, Banyo, Queensland, Australia.,Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK.,Research Unit for Schizophrenia Epidemiology, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.,Neuroscience Research Australia, Randwick, New South Wales, Australia
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Aggernæs B. Autism: a transdiagnostic, dimensional, construct of reasoning? Eur J Neurosci 2018; 47:515-533. [PMID: 28452080 PMCID: PMC6084350 DOI: 10.1111/ejn.13599] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 04/17/2017] [Accepted: 04/19/2017] [Indexed: 12/11/2022]
Abstract
The concept of autism has changed across time, from the Bleulerian concept, which defined it as one of several symptoms of dementia praecox, to the present-day concept representing a pervasive development disorder. The present theoretical contribution to this special issue of EJN on autism introduces new theoretical ideas and discusses them in light of selected prior theories, clinical examples, and recent empirical evidence. The overall aim is to identify some present challenges of diagnostic practice and autism research and to suggest new pathways that may help direct future research. Future research must agree on the definitions of core concepts such as autism and psychosis. A possible redefinition of the concept of autism may be a condition in which the rationale of an individual's behaviour differs qualitatively from that of the social environment due to characteristic cognitive impairments affecting reasoning. A broad concept of psychosis could focus on deviances in the experience of reality resulting from impairments of reasoning. In this light and consistent with recent empirical evidence, it may be appropriate to redefine dementia praecox as a developmental disorder of reasoning. A future challenge of autism research may be to develop theoretical models that can account for the impact of complex processes acting at the social level in addition to complex neurobiological and psychological processes. Such models could profit from a distinction among processes related to (i) basic susceptibility, (ii) adaptive processes and (iii) decompensating factors involved in the development of manifest illness.
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Affiliation(s)
- Bodil Aggernæs
- Department of Child and Adolescent PsychiatryPsychiatry Region ZealandNy Østergade 12DK‐4000RoskildeDenmark
- Faculty of Medical and Health SciencesDepartment of Clinical MedicineUniversity of CopenhagenBlegdamsvej 3BDK‐2200 Copenhagen NDenmark
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35
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Kesby JP, Eyles DW, McGrath JJ, Scott JG. Dopamine, psychosis and schizophrenia: the widening gap between basic and clinical neuroscience. Transl Psychiatry 2018; 8:30. [PMID: 29382821 PMCID: PMC5802623 DOI: 10.1038/s41398-017-0071-9] [Citation(s) in RCA: 190] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 10/10/2017] [Accepted: 10/26/2017] [Indexed: 12/18/2022] Open
Abstract
The stagnation in drug development for schizophrenia highlights the need for better translation between basic and clinical research. Understanding the neurobiology of schizophrenia presents substantial challenges but a key feature continues to be the involvement of subcortical dopaminergic dysfunction in those with psychotic symptoms. Our contemporary knowledge regarding dopamine dysfunction has clarified where and when dopaminergic alterations may present in schizophrenia. For example, clinical studies have shown patients with schizophrenia show increased presynaptic dopamine function in the associative striatum, rather than the limbic striatum as previously presumed. Furthermore, subjects deemed at high risk of developing schizophrenia show similar presynaptic dopamine abnormalities in the associative striatum. Thus, our view of subcortical dopamine function in schizophrenia continues to evolve as we accommodate this newly acquired information. However, basic research in animal models has been slow to incorporate these clinical findings. For example, psychostimulant-induced locomotion, the commonly utilised phenotype for positive symptoms in rodents, is heavily associated with dopaminergic activation in the limbic striatum. This anatomical misalignment has brought into question how we assess positive symptoms in animal models and represents an opportunity for improved translation between basic and clinical research. The current review focuses on the role of subcortical dopamine dysfunction in psychosis and schizophrenia. We present and discuss alternative phenotypes that may provide a more translational approach to assess the neurobiology of positive symptoms in schizophrenia. Incorporation of recent clinical findings is essential if we are to develop meaningful translational animal models.
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Affiliation(s)
- JP Kesby
- 0000 0000 9320 7537grid.1003.2Queensland Brain Institute, The University of Queensland, St. Lucia, QLD Australia ,0000 0000 9320 7537grid.1003.2Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, QLD Australia
| | - DW Eyles
- 0000 0000 9320 7537grid.1003.2Queensland Brain Institute, The University of Queensland, St. Lucia, QLD Australia ,0000 0004 0606 3563grid.417162.7Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD Australia
| | - JJ McGrath
- 0000 0000 9320 7537grid.1003.2Queensland Brain Institute, The University of Queensland, St. Lucia, QLD Australia ,0000 0004 0606 3563grid.417162.7Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD Australia ,0000 0001 1956 2722grid.7048.bNational Centre for Register-based Research, Aarhus University, Aarhus C, Denmark
| | - JG Scott
- 0000 0000 9320 7537grid.1003.2Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, QLD Australia ,0000 0004 0606 3563grid.417162.7Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD Australia ,0000 0001 0688 4634grid.416100.2Metro North Mental Health, Royal Brisbane and Women’s Hospital, Herston, QLD Australia
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36
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Jolley S, Browning S, Corrigall R, Laurens KR, Hirsch C, Bracegirdle K, Gin K, Muccio F, Stewart C, Banerjea P, Kuipers E, Garety P, Byrne M, Onwumere J, Achilla E, McCrone P, Emsley R. Coping with Unusual ExperienceS for 12-18 year olds (CUES+): a transdiagnostic randomised controlled trial of the effectiveness of cognitive therapy in reducing distress associated with unusual experiences in adolescent mental health services: study protocol for a randomised controlled trial. Trials 2017; 18:586. [PMID: 29202862 PMCID: PMC5716372 DOI: 10.1186/s13063-017-2326-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 11/13/2017] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Childhood 'unusual experiences' (such as hearing voices that others cannot, or suspicions of being followed) are common, but can become more distressing during adolescence, especially for young people in contact with Child and Adolescent Mental Health Services (CAMHS). Unusual experiences that are distressing or have adverse life impact (UEDs) are associated with a range of current and future emotional, behavioural and mental health difficulties. Recommendations for psychological intervention are based on evidence from adult studies, with some support from small, pilot, child-specific evaluations. Research is needed to ensure that the recommendations suit children as well as adults. The CUES+ study (Coping with Unusual ExperienceS for 12-18 year olds) aims to find out whether cognitive behaviour therapy for UEDs (CBT-UED) is a helpful and cost-effective addition to usual community care for 12-18 year olds presenting to United Kingdom National Health Service Child and Adolescent Mental Health Services in four London boroughs. METHODS The CUES+ study is a randomised controlled trial comparing CBT-UED plus routine care to routine care alone. CBT-UED comprises up to 16 sessions, including up to 12 individual and up to four family support meetings, each lasting around 45-60 min, delivered weekly. The primary outcome is emotional distress. Secondary outcomes are change in UEDs, risk events (self-harm, attendance at emergency services, other adverse events) and health economic outcomes. Participants will be randomised in a 1:1 ratio after baseline assessment. Randomisation will be stratified by borough and by severity of mental health presentation: 'severe' (an identified psychotic or bipolar disorder) or any 'other' condition. Outcomes will be assessed by a trained assessor blind to treatment condition at 0, 16 and 24 weeks. Recruitment began in February, 2015 and is ongoing until the end of March, 2017. DISCUSSION The CUES+ study will contribute to the currently limited child-specific evidence base for psychological interventions for UEDs occurring in the context of psychosis or any other mental health presentation. TRIAL REGISTRATION International Standard Randomised Controlled Trials, ID: ISRCTN21802136 . Prospectively registered on 12 January 2015. Protocol V3 31 August 2015 with screening amended.
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Affiliation(s)
- Suzanne Jolley
- Department of Psychology, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, 16, De Crespigny Park, Denmark Hill, London, SE5 8AF UK
| | - Sophie Browning
- South London and Maudsley NHS Foundation Trust, London, SE5 8AZ UK
| | | | - Kristin R. Laurens
- School of Psychology, Faculty of Health Sciences, Australian Catholic University, Banyo, QLD 4014 Australia
- Department of Forensic and Neurodevelopmental Sciences, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, SE5 8AF UK
- Research Unit for Schizophrenia Epidemiology, School of Psychiatry, University of New South Wales, Sydney, NSW 2052 Australia
- Neuroscience Research Australia, Randwick, NSW 2031 Australia
| | - Colette Hirsch
- Department of Psychology, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, 16, De Crespigny Park, Denmark Hill, London, SE5 8AF UK
- National Institute for Health Research Mental Health Biomedical Research Centre and Dementia Unit (BRC/U) at the South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, SE5 8AZ UK
| | | | - Kimberley Gin
- South London and Maudsley NHS Foundation Trust, London, SE5 8AZ UK
| | - Francesca Muccio
- South London and Maudsley NHS Foundation Trust, London, SE5 8AZ UK
| | - Catherine Stewart
- Department of Psychology, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, 16, De Crespigny Park, Denmark Hill, London, SE5 8AF UK
- South London and Maudsley NHS Foundation Trust, London, SE5 8AZ UK
| | - Partha Banerjea
- South London and Maudsley NHS Foundation Trust, London, SE5 8AZ UK
| | - Elizabeth Kuipers
- Department of Psychology, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, 16, De Crespigny Park, Denmark Hill, London, SE5 8AF UK
- National Institute for Health Research Mental Health Biomedical Research Centre and Dementia Unit (BRC/U) at the South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, SE5 8AZ UK
| | - Philippa Garety
- Department of Psychology, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, 16, De Crespigny Park, Denmark Hill, London, SE5 8AF UK
- National Institute for Health Research Mental Health Biomedical Research Centre and Dementia Unit (BRC/U) at the South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, SE5 8AZ UK
| | - Majella Byrne
- Department of Psychology, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, 16, De Crespigny Park, Denmark Hill, London, SE5 8AF UK
- South London and Maudsley NHS Foundation Trust, London, SE5 8AZ UK
| | - Juliana Onwumere
- Department of Psychology, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, 16, De Crespigny Park, Denmark Hill, London, SE5 8AF UK
| | - Evanthia Achilla
- Department of Health Service and Population Research, King’s Health Economics, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, SE5 8AF UK
| | - Paul McCrone
- Department of Health Service and Population Research, King’s Health Economics, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, SE5 8AF UK
| | - Richard Emsley
- Centre for Biostatistics, School of Health Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PL UK
- Manchester Academic Health Science Centre Clinical Trials Unit, Manchester, M13 9PL UK
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37
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Cullen AE, Tappin BM, Zunszain PA, Dickson H, Roberts RE, Nikkheslat N, Khondoker M, Pariante CM, Fisher HL, Laurens KR. The relationship between salivary C-reactive protein and cognitive function in children aged 11-14years: Does psychopathology have a moderating effect? Brain Behav Immun 2017; 66:221-229. [PMID: 28694011 PMCID: PMC5773474 DOI: 10.1016/j.bbi.2017.07.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Revised: 06/29/2017] [Accepted: 07/03/2017] [Indexed: 01/22/2023] Open
Abstract
Elevated C-reactive protein (CRP), a non-specific biomarker of systemic bodily inflammation, has been associated with more pronounced cognitive impairments in adults with psychiatric disorders, particularly in the domains of memory and executive function. Whether this association is present in early life (i.e., the time at which the cognitive impairments that characterise these disorders become evident), and is specific to those with emerging psychiatric disorders, has yet to be investigated. To this end, we examined the association between salivary CRP and cognitive function in children aged 11-14years and explored the moderating effect of psychopathology. The study utilised data from an established longitudinal investigation of children recruited from the community (N=107) that had purposively over-sampled individuals experiencing psychopathology (determined using questionnaires). CRP was measured in saliva samples and participants completed assessments of cognition (memory and executive function) and psychopathology (internalising and externalising symptoms and psychotic-like experiences). Linear regression models indicated that higher salivary CRP was associated with poorer letter fluency (β=-0.24, p=0.006) and scores on the inhibition (β=-0.28, p=0.004) and inhibition/switching (β=-0.36, p<0.001) subtests of the colour-word interference test, but not with performance on any of the memory tasks (working, visual, and verbal memory tasks). Results were largely unchanged after adjustment for psychopathology and no significant interactions between CRP and psychopathology were observed on any cognitive measure. Our findings provide preliminary evidence that elevated salivary CRP is associated with poorer cognitive function in early life, but that this association is not moderated by concurrent psychopathology. These findings have implications for early intervention strategies that attempt to ameliorate cognitive deficits associated with emerging psychiatric disorders. Further research is needed to determine whether salivary CRP levels can be used as a valid marker of peripheral inflammation among healthy adolescents.
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Affiliation(s)
- Alexis E Cullen
- Department of Psychosis Studies, King's College London, London, UK.
| | - Ben M Tappin
- ARC Centre of Excellence in Cognition and its Disorders, Department of Psychology, Royal Holloway, University of London, UK
| | - Patricia A Zunszain
- Section of Stress, Psychiatry and Immunology & Perinatal Psychiatry, Department of Psychological Medicine, King's College London, London, UK
| | - Hannah Dickson
- Department of Forensic and Neurodevelopmental Sciences, King's College London, London, UK
| | - Ruth E Roberts
- Department of Forensic and Neurodevelopmental Sciences, King's College London, London, UK
| | - Naghmeh Nikkheslat
- Section of Stress, Psychiatry and Immunology & Perinatal Psychiatry, Department of Psychological Medicine, King's College London, London, UK
| | | | - Carmine M Pariante
- Section of Stress, Psychiatry and Immunology & Perinatal Psychiatry, Department of Psychological Medicine, King's College London, London, UK
| | - Helen L Fisher
- MRC Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Kristin R Laurens
- Department of Forensic and Neurodevelopmental Sciences, King's College London, London, UK; School of Psychology, Australian Catholic University, Brisbane, Australia; Research Unit for Schizophrenia Epidemiology, School of Psychiatry, University of New South Wales, Sydney, Australia; Neuroscience Research Australia, Sydney, Australia.
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38
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Gronholm PC, Thornicroft G, Laurens KR, Evans-Lacko S. Conditional Disclosure on Pathways to Care: Coping Preferences of Young People at Risk of Psychosis. QUALITATIVE HEALTH RESEARCH 2017; 27:1842-1855. [PMID: 27909250 DOI: 10.1177/1049732316680337] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The interrelationship between stigma and help-seeking is under-researched among children and adolescents. This study explored stigma in relation to pathways to care among young people putatively in an early stage of increased risk of developing psychotic disorders. "Pathways to care" was defined as help-seeking and support from informal and formal resources, and increased risk was determined through the presence of persistent psychotic-like experiences and internalizing/externalizing psychopathology. Twenty-nine qualitative interviews were analyzed using thematic analysis. We defined the superordinate theme in these data as "conditional disclosure," a concept reflecting the rules and prerequisites that influenced how/whether participants sought help. Through parallels between these findings and established stigma theory, we examined how these conditions could be interpreted as influenced by stigma. Our findings demonstrate the influence of stigma on young people's perceptions of a range of pre-clinical symptoms, and on how they seek support for these symptoms.
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Key Words
- Western Europe, Britain
- adolescents, youth, young adults, at risk
- adolescents, youth, young adults, mental health and illness
- children, illness and disease
- community and public health
- confidentiality, privacy, disclosure
- health care, access to
- health, health promotion
- illness and disease
- prevention
- psychology, psychological issues
- qualitative
- research strategies, interviews
- research strategies, thematic analysis
- social support
- stigma
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Affiliation(s)
- Petra C Gronholm
- 1 Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Graham Thornicroft
- 1 Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Kristin R Laurens
- 1 Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
- 2 University of New South Wales, Sydney, New South Wales, Australia
- 3 Schizophrenia Research Institute, Sydney, New South Wales, Australia
- 4 Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Sara Evans-Lacko
- 1 Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
- 5 Personal Social Services Research Unit, London School of Economics and Political Science, London, United Kingdom
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Abidi S, Mian I, Garcia-Ortega I, Lecomte T, Raedler T, Jackson K, Jackson K, Pringsheim T, Addington D. Canadian Guidelines for the Pharmacological Treatment of Schizophrenia Spectrum and Other Psychotic Disorders in Children and Youth. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2017; 62:635-647. [PMID: 28764561 PMCID: PMC5593251 DOI: 10.1177/0706743717720197] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Schizophrenia spectrum and other psychotic disorders often have their onset in adolescence. The sequelae of these illnesses can negatively alter the trajectory of emotional, cognitive, and social development in children and youth if left untreated. Early and appropriate interventions can improve outcomes. This article aims to identify best practices in the pharmacotherapy management of children and youth with schizophrenia spectrum disorders. METHODS A systematic search was conducted for published guidelines for schizophrenia and schizophrenia spectrum disorders in children and youth (under age 18 years). Recommendations were drawn from the National Institute for Health and Care Excellence guidelines on psychosis and schizophrenia in children and youth (2013 and 2015 updates). Current guidelines were adopted using the ADAPTE process, which includes consensus ratings by a panel of experts. RESULTS Recommendations identified covered a range of issues in the pharmacotherapy management of children and youth with schizophrenia spectrum disorders. Further work in this area is warranted as we continue to further understand their presentation in the developing brain. CONCLUSIONS Canadian guidelines for the pharmacotherapy management of children and youth with schizophrenia spectrum disorders are essential to assist clinicians in treating this vulnerable population. Ongoing work in this area is recommended.
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Affiliation(s)
- Sabina Abidi
- 1 Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia
| | - Irfan Mian
- 2 Department of Psychiatry, University of Toronto, Toronto, Ontario
| | | | - Tania Lecomte
- 4 Department of Psychology, University of Montreal, Montreal, Quebec
| | - Thomas Raedler
- 5 Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta
| | - Kevin Jackson
- 6 Schizophrenia Society of Alberta, Lethbridge, Alberta
| | - Kim Jackson
- 6 Schizophrenia Society of Alberta, Lethbridge, Alberta
| | - Tamara Pringsheim
- 7 Mathison Centre for Mental Health Research and Education, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta
| | - Donald Addington
- 7 Mathison Centre for Mental Health Research and Education, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta
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Pruessner M, Cullen AE, Aas M, Walker EF. The neural diathesis-stress model of schizophrenia revisited: An update on recent findings considering illness stage and neurobiological and methodological complexities. Neurosci Biobehav Rev 2017; 73:191-218. [DOI: 10.1016/j.neubiorev.2016.12.013] [Citation(s) in RCA: 131] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 12/09/2016] [Accepted: 12/12/2016] [Indexed: 01/29/2023]
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Tonin FS, Wiens A, Fernandez-Llimos F, Pontarolo R. Iloperidone in the treatment of schizophrenia: an evidence-based review of its place in therapy. CORE EVIDENCE 2016; 11:49-61. [PMID: 28008301 PMCID: PMC5167526 DOI: 10.2147/ce.s114094] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Introduction Schizophrenia is a chronic and debilitating mental disorder that affects the patient’s and their family’s quality of life, as well as financial costs and health care settings. Despite the variety of available antipsychotics, optimal treatment outcomes are not always achieved. Novel drugs, such as iloperidone, can provide more effective, tolerable and safer strategies. Aim To review the evidence for the clinical impact of iloperidone on the treatment of patients with schizophrenia. Evidence review Clinical trials, observational studies and meta-analyses reached a common consensus that iloperidone is as effective as haloperidol, risperidone and ziprasidone in reducing schizophrenia symptoms. Similar amounts of adverse events and discontinuations were observed with iloperidone compared to placebo and active treatments. Common adverse events are mild and include dizziness, hypotension, dry mouth and weight gain. Iloperidone can induce extension of QTc interval, and clinicians should be aware of its contraindications. In long-term trials, iloperidone also showed promising safety and tolerability profiles. The low propensity to cause akathisia, extrapyramidal symptoms (EPS), increased prolactin levels or changes to metabolic laboratory parameters support its use in practice. Results showed that iloperidone prevents relapse in stabilized patients, with a time to relapse superior to placebo and similar to haloperidol. Patients using a prior antipsychotic (eg, risperidone and aripiprazole) can easily switch to iloperidone with no serious impact on safety or efficacy. However, the acquisition costs of iloperidone may hamper its use. Further evidence comparing iloperidone with other antipsychotics, and pharmacoeconomic studies would be welcome. Place in therapy Considering just the clinical profile of iloperidone, it represents a promising drug for treating schizophrenia, particularly in patients who are intolerant to previous antipsychotics, as well as being suitable as first-line therapy. Cost-effectiveness comparisons are needed to justify its use in clinical practice.
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Affiliation(s)
| | - Astrid Wiens
- Department of Pharmacy, Federal University of Parana, Curitiba, Brazil
| | - Fernando Fernandez-Llimos
- Department of Social Pharmacy, Faculty of Pharmacy, Research Institute for Medicines (iMed.ULisboa), Universidade de Lisboa, Lisbon, Portugal
| | - Roberto Pontarolo
- Department of Pharmacy, Federal University of Parana, Curitiba, Brazil
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Affiliation(s)
- Ulrich Reininghaus
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616 (VIJV1), 6200 MD, Maastricht, The Netherlands.
- Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Katherine M Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Craig Morgan
- Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre (BRC) at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
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Davis J, Eyre H, Jacka FN, Dodd S, Dean O, McEwen S, Debnath M, McGrath J, Maes M, Amminger P, McGorry PD, Pantelis C, Berk M. A review of vulnerability and risks for schizophrenia: Beyond the two hit hypothesis. Neurosci Biobehav Rev 2016; 65:185-94. [PMID: 27073049 PMCID: PMC4876729 DOI: 10.1016/j.neubiorev.2016.03.017] [Citation(s) in RCA: 201] [Impact Index Per Article: 25.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 03/25/2016] [Accepted: 03/25/2016] [Indexed: 01/15/2023]
Abstract
Schizophrenia risk has often been conceptualized using a model which requires two hits in order to generate the clinical phenotype-the first as an early priming in a genetically predisposed individual and the second a likely environmental insult. The aim of this paper was to review the literature and reformulate this binary risk-vulnerability model. We sourced the data for this narrative review from the electronic database PUBMED. Our search terms were not limited by language or date of publication. The development of schizophrenia may be driven by genetic vulnerability interacting with multiple vulnerability factors including lowered prenatal vitamin D exposure, viral infections, smoking intelligence quotient, social cognition cannabis use, social defeat, nutrition and childhood trauma. It is likely that these genetic risks, environmental risks and vulnerability factors are cumulative and interactive with each other and with critical periods of neurodevelopmental vulnerability. The development of schizophrenia is likely to be more complex and nuanced than the binary two hit model originally proposed nearly thirty years ago. Risk appears influenced by a more complex process involving genetic risk interfacing with multiple potentially interacting hits and vulnerability factors occurring at key periods of neurodevelopmental activity, which culminate in the expression of disease state. These risks are common across a number of neuropsychiatric and medical disorders, which might inform common preventive and intervention strategies across non-communicable disorders.
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Affiliation(s)
- Justin Davis
- Deakin University, IMPACT Strategic Research Centre, School of Medicine, Barwon Health, P.O. Box 291, Geelong, 3220, Australia.
| | - Harris Eyre
- Deakin University, IMPACT Strategic Research Centre, School of Medicine, Barwon Health, P.O. Box 291, Geelong, 3220, Australia
| | - Felice N Jacka
- Deakin University, IMPACT Strategic Research Centre, School of Medicine, Barwon Health, P.O. Box 291, Geelong, 3220, Australia; University of Melbourne, Department of Psychiatry, Level 1 North, Main Block, Royal Melbourne Hospital, Parkville, 3052, Australia; Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, Australia; Black Dog Institute, Sydney, Australia
| | - Seetal Dodd
- Deakin University, IMPACT Strategic Research Centre, School of Medicine, Barwon Health, P.O. Box 291, Geelong, 3220, Australia; University of Melbourne, Department of Psychiatry, Level 1 North, Main Block, Royal Melbourne Hospital, Parkville, 3052, Australia
| | - Olivia Dean
- Deakin University, IMPACT Strategic Research Centre, School of Medicine, Barwon Health, P.O. Box 291, Geelong, 3220, Australia; University of Melbourne, Department of Psychiatry, Level 1 North, Main Block, Royal Melbourne Hospital, Parkville, 3052, Australia
| | - Sarah McEwen
- Semel Institute for Neuroscience and Human Behavior, UCLA, United States
| | - Monojit Debnath
- Department of Human Genetics, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - John McGrath
- Queensland Brain Institute, The University of Queensland, Brisbane, 4072, Queensland, Australia; Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Queensland 4076, Australia
| | - Michael Maes
- Deakin University, IMPACT Strategic Research Centre, School of Medicine, Barwon Health, P.O. Box 291, Geelong, 3220, Australia
| | - Paul Amminger
- Queensland Brain Institute, The University of Queensland, Brisbane, 4072, Queensland, Australia; Orygen, The National Centre of Excellence in Youth Mental Health and Orygen Youth Health Research Centre, 35 Poplar Rd., Parkville, 3052, Australia
| | - Patrick D McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health and Orygen Youth Health Research Centre, 35 Poplar Rd., Parkville, 3052, Australia; Centre of Youth Mental Health, University of Melbourne, 35 Poplar Rd., Parkville, 3052, Australia
| | - Christos Pantelis
- University of Melbourne, Department of Psychiatry, Level 1 North, Main Block, Royal Melbourne Hospital, Parkville, 3052, Australia; Department of Human Genetics, National Institute of Mental Health and Neurosciences, Bangalore, India; Melbourne Neuropsychiatry Centre, The University of Melbourne & Melbourne Health, Parkville, 3052, Australia; Florey Institute for Neuroscience and Mental Health, University of Melbourne, Kenneth Myer Building, 30 Royal Parade, 3052, Parkville, Australia
| | - Michael Berk
- Deakin University, IMPACT Strategic Research Centre, School of Medicine, Barwon Health, P.O. Box 291, Geelong, 3220, Australia; University of Melbourne, Department of Psychiatry, Level 1 North, Main Block, Royal Melbourne Hospital, Parkville, 3052, Australia; Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Queensland 4076, Australia; Orygen, The National Centre of Excellence in Youth Mental Health and Orygen Youth Health Research Centre, 35 Poplar Rd., Parkville, 3052, Australia; Centre of Youth Mental Health, University of Melbourne, 35 Poplar Rd., Parkville, 3052, Australia; Florey Institute for Neuroscience and Mental Health, University of Melbourne, Kenneth Myer Building, 30 Royal Parade, 3052, Parkville, Australia
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Childhood antecedents of schizophrenia: Will understanding aetiopathogenesis result in schizophrenia prevention? Soc Psychiatry Psychiatr Epidemiol 2016; 51:493-5. [PMID: 26825648 DOI: 10.1007/s00127-016-1184-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 01/17/2016] [Indexed: 10/22/2022]
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