1
|
Walter N, Wenzel J, Haas SS, Squarcina L, Bonivento C, Ruef A, Dwyer D, Lichtenstein T, Bastrük Ö, Stainton A, Antonucci LA, Brambilla P, Wood SJ, Upthegrove R, Borgwardt S, Lencer R, Meisenzahl E, Salokangas RKR, Pantelis C, Bertolino A, Koutsouleris N, Kambeitz J, Kambeitz-Ilankovic L. A multivariate cognitive approach to predict social functioning in recent onset psychosis in response to computerized cognitive training. Prog Neuropsychopharmacol Biol Psychiatry 2024; 128:110864. [PMID: 37717645 DOI: 10.1016/j.pnpbp.2023.110864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/01/2023] [Accepted: 09/13/2023] [Indexed: 09/19/2023]
Abstract
Clinical and neuroimaging data has been increasingly used in recent years to disentangle heterogeneity of treatment response to cognitive training (CT) and predict which individuals may achieve the highest benefits. CT has small to medium effects on improving cognitive and social functioning in recent onset psychosis (ROP) patients, who show the most profound cognitive and social functioning deficits among psychiatric patients. We employed multivariate pattern analysis (MVPA) to investigate the potential of cognitive data to predict social functioning improvement in response to 10 h of CT in patients with ROP. A support vector machine (SVM) classifier was trained on the naturalistic data of the Personalized Prognostic Tools for Early Psychosis Management (PRONIA) study sample to predict functioning in an independent sample of 70 ROP patients using baseline cognitive data. PRONIA is a part of a FP7 EU grant program that involved 7 sites across 5 European countries, designed and conducted with the main aim of identifying (bio)markers associated with an enhanced risk of developing psychosis in order to improve early detection and prognosis. Social functioning was predicted with a balanced accuracy (BAC) of 66.4% (Sensitivity 78.8%; Specificity 54.1%; PPV 60.5%; NPV 74.1%; AUC 0.64; P = 0.01). The most frequently selected cognitive features (mean feature weights > ± 0.2) included the (1) correct number of symbol matchings within the Digit Symbol Substitution Test, (2) the number of distracting stimuli leading to an error within 300 and 200 trials in the Continuous Performance Test and (3) the dynamics of verbal fluency between 15 and 30 s within the Verbal Fluency Test, phonetic part. Next, the SVM classifier generated on the PRONIA sample was applied to the intervention sample, that obtained 54 ROP patients who were randomly assigned to a social cognitive training (SCT) or treatment as usual (TAU) group and dichotomized into good (GF-S ≥ 7) and poor (GF-S < 7) functioning patients based on their level of Global Functioning-Social (GF-S) score at follow-up (FU). By applying the initial PRONIA classifier, using out-of-sample cross-validation (OOCV) to the sample of ROP patients who have undergone the CT intervention, a BAC of 59.3% (Sensitivity 70.4%; Specificity 48.1%; PPV 57.6%; NPV 61.9%; AUC 0.63) was achieved at T0 and a BAC of 64.8% (Sensitivity 66.7%; Specificity 63.0%; PPV 64.3%; NPV 65.4%; AUC 0.66) at FU. After SCT intervention, a significant improvement in predicted social functioning values was observed in the SCT compared to TAU group (P ≤0.05; ES[Cohens' d] = 0.18). Due to a small sample size and modest variance of social functioning of the intervention sample it was not feasible to predict individual response to SCT in the current study. Our findings suggest that the use of baseline cognitive data could provide a robust individual estimate of future social functioning, while prediction of individual response to SCT using cognitive data that can be generated in the routine patient care remains to be addressed in large-scale cognitive training trials.
Collapse
Affiliation(s)
- Nina Walter
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Kerpenerstr.62, 50931, Cologne, Germany
| | - Julian Wenzel
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Kerpenerstr.62, 50931, Cologne, Germany
| | - Shalaila S Haas
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, NY, New York, United States of America
| | | | | | - Anne Ruef
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany
| | - Dominic Dwyer
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany; Orygen Youth Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Theresa Lichtenstein
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Kerpenerstr.62, 50931, Cologne, Germany
| | - Öznur Bastrük
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Kerpenerstr.62, 50931, Cologne, Germany
| | - Alexandra Stainton
- Orygen Youth Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Linda A Antonucci
- Department of Translational Biomedicine and Neuroscience, University of Bari Aldo Moro, Bari, Italy
| | - Paolo Brambilla
- Department of Neuosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Mental Health, University of Milan, Milan, Italy
| | - Stephen J Wood
- Orygen Youth Health, Melbourne, Australia; School of Psychology, University of Birmingham, United Kingdom; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Rachel Upthegrove
- School of Psychology, University of Birmingham, United Kingdom; Institute of Mental Health, University of Birmingham, Birmingham, United Kingdom
| | - Stefan Borgwardt
- Translational Psychiatry Unit (TPU), Department of Psychiatry and Psychotherapy, University of Luebeck, Germany
| | - Rebekka Lencer
- Translational Psychiatry Unit (TPU), Department of Psychiatry and Psychotherapy, University of Luebeck, Germany
| | - Eva Meisenzahl
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | | | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne & NorthWestern Mental Health, Melbourne, Australia
| | - Alessandro Bertolino
- Department of Translational Biomedicine and Neuroscience, University of Bari Aldo Moro, Bari, Italy
| | - Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany; Max Planck Institute for Psychiatry, Munich, Germany; Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, King's College London, London, United Kingdom
| | - Joseph Kambeitz
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Kerpenerstr.62, 50931, Cologne, Germany
| | - Lana Kambeitz-Ilankovic
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Kerpenerstr.62, 50931, Cologne, Germany; Faculty of Psychology and Educational Sciences, Department of Psychology, Ludwig-Maximilian University, Munich, Germany.
| |
Collapse
|
2
|
Lucarini V, Kazes M, Krebs E, Morin V, Godignon M, De Gasquet M, Ton T, Féron M, Tanguy G, Lévi A, Bellot C, Willard D, Auther AM, Cornblatt B, Bralet MC, Krebs MO. Validation of the French version of the Global Functioning: Social and Global Functioning: Role Scales in adolescents and young adults seeking help in early intervention clinics. Early Interv Psychiatry 2024; 18:3-9. [PMID: 37037927 DOI: 10.1111/eip.13427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/28/2023] [Indexed: 04/12/2023]
Abstract
AIM Social and role functioning impairments characterize patients along the schizophrenia spectrum, but the existing evaluations tools do not specifically address younger population issues. The Global Functioning Social (GF:S) and Global Functioning Role (GF:R) scales have been specifically designed for that purpose. The aim of this study is to establish the reliability and concurrent validity of the French version of GF:S and GF:R scales. METHODS The two scales GF: Social (GF:S) and Role (GF:R) have first been translated into French and independently back translated and validated by the original authors. Between March 2021 and March 2022, we enrolled 51 participants (20.3 ± 3.7 years old; female = 22/51) amongst help-seekers referring to two different early mental health services in the Île-de-France. In an ecological design, participants met different diagnoses, 7 (13.7%) met the criteria for Ultra-High Risk of psychosis (UHR) using CAARMS criteria. RESULTS Inter-rater reliability was excellent for scores related to the past month and to the higher levels of functioning over the past year. Both scales showed good to excellent concurrent validity as measured by correlation with the Social and Occupational Functioning Assessment Scale (SOFAS) and the Personal and Social Performance Scale (PSP). CONCLUSION Overall, this study confirms the reliability and validity of the French version of the GF:S and GF:R scales. The use of these scales may improve the evaluation of social and occupational functioning in French-speaking young help-seekers, in a transdiagnostic approach, both in clinical and research settings.
Collapse
Affiliation(s)
- Valeria Lucarini
- Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Université Paris Cité, Paris, France
- CJAAD, Evaluation, Prevention and Therapeutic Innovation Department, GHU Paris Psychiatrie et Neurosciences, Paris, France
- Institut de Psychiatrie, CNRS GDR 3557, Paris, France
| | - Mathilde Kazes
- CJAAD, Evaluation, Prevention and Therapeutic Innovation Department, GHU Paris Psychiatrie et Neurosciences, Paris, France
- Institut de Psychiatrie, CNRS GDR 3557, Paris, France
| | - Emma Krebs
- Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Université Paris Cité, Paris, France
- Institut de Psychiatrie, CNRS GDR 3557, Paris, France
| | - Valentine Morin
- Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Université Paris Cité, Paris, France
- CJAAD, Evaluation, Prevention and Therapeutic Innovation Department, GHU Paris Psychiatrie et Neurosciences, Paris, France
- Institut de Psychiatrie, CNRS GDR 3557, Paris, France
| | - Maud Godignon
- CJAAD, Evaluation, Prevention and Therapeutic Innovation Department, GHU Paris Psychiatrie et Neurosciences, Paris, France
| | - Marie De Gasquet
- Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Université Paris Cité, Paris, France
- CJAAD, Evaluation, Prevention and Therapeutic Innovation Department, GHU Paris Psychiatrie et Neurosciences, Paris, France
- Institut de Psychiatrie, CNRS GDR 3557, Paris, France
| | - Trang Ton
- Institut de Psychiatrie, CNRS GDR 3557, Paris, France
- JENESIS/CRISALID, Pôle PRERPS, CHI EPSM Oise, Clermont de l'Oise, France
| | - Marion Féron
- Institut de Psychiatrie, CNRS GDR 3557, Paris, France
- JENESIS/CRISALID, Pôle PRERPS, CHI EPSM Oise, Clermont de l'Oise, France
| | - Guillaume Tanguy
- CJAAD, Evaluation, Prevention and Therapeutic Innovation Department, GHU Paris Psychiatrie et Neurosciences, Paris, France
| | - Agnès Lévi
- CJAAD, Evaluation, Prevention and Therapeutic Innovation Department, GHU Paris Psychiatrie et Neurosciences, Paris, France
| | - Cécile Bellot
- CJAAD, Evaluation, Prevention and Therapeutic Innovation Department, GHU Paris Psychiatrie et Neurosciences, Paris, France
| | - Dominique Willard
- Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Université Paris Cité, Paris, France
- CJAAD, Evaluation, Prevention and Therapeutic Innovation Department, GHU Paris Psychiatrie et Neurosciences, Paris, France
- Institut de Psychiatrie, CNRS GDR 3557, Paris, France
| | - Andrea M Auther
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York, New York, USA
- Department of Psychiatry, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Barbara Cornblatt
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York, New York, USA
- Department of Psychiatry, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
- Center for Psychiatric Neuroscience, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA
- Department of Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Marie-Cécile Bralet
- Institut de Psychiatrie, CNRS GDR 3557, Paris, France
- JENESIS/CRISALID, Pôle PRERPS, CHI EPSM Oise, Clermont de l'Oise, France
| | - Marie-Odile Krebs
- Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Université Paris Cité, Paris, France
- CJAAD, Evaluation, Prevention and Therapeutic Innovation Department, GHU Paris Psychiatrie et Neurosciences, Paris, France
- Institut de Psychiatrie, CNRS GDR 3557, Paris, France
| |
Collapse
|
3
|
Crowter L, Banerjee R, Berry C, Fowler D. Schematic beliefs, negative affect and paranoia in at-risk youth. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2022; 61:1038-1051. [PMID: 35762490 DOI: 10.1111/bjc.12373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 03/08/2022] [Accepted: 05/03/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Attenuated symptoms of psychosis are a core feature of At-Risk Mental States. However, subthreshold levels of paranoia are also common among nonpsychosis populations. At present, little is known about whether the processes underpinning the experience of paranoid ideation in high-risk youth differ as a consequence of meeting At-Risk Mental States (ARMS) for psychosis criteria. METHODS This study utilized path analysis techniques to examine the relationships between schematic beliefs, negative affect and the experience of paranoia for two groups: a group meeting criteria for ARMS (n = 133) and a group presenting with emerging complex mental health difficulties who did not meet the criteria for ARMS (n = 137). RESULTS While the ARMS group displayed significantly greater maladaptive schematic beliefs and more severe symptomatology, the associations between schematic beliefs, symptoms of negative affect and paranoia did not differ as a consequence of ARMS status. CONCLUSIONS While meeting the ARMS criteria is associated with experiencing more maladaptive cognitions and more negative symptomatology among at-risk youth, the associations between these cognitive beliefs and symptoms may be similar for youth who do not meet ARMS. These findings have implications for broadening the scope of at-risk/high-risk and for developing effective interventions for young people presenting with emerging difficulties.
Collapse
Affiliation(s)
| | | | - Clio Berry
- Brighton and Sussex Medical School, Sussex, UK
| | - David Fowler
- University of Sussex, Sussex, UK.,Sussex Partnership NHS Foundation Trust, Sussex, UK
| |
Collapse
|
4
|
Catalan A, Salazar de Pablo G, Vaquerizo Serrano J, Mosillo P, Baldwin H, Fernández-Rivas A, Moreno C, Arango C, Correll CU, Bonoldi I, Fusar-Poli P. Annual Research Review: Prevention of psychosis in adolescents - systematic review and meta-analysis of advances in detection, prognosis and intervention. J Child Psychol Psychiatry 2021; 62:657-673. [PMID: 32924144 DOI: 10.1111/jcpp.13322] [Citation(s) in RCA: 85] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 06/20/2020] [Accepted: 07/31/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND The clinical high-risk state for psychosis (CHR-P) paradigm has facilitated the implementation of psychosis prevention into clinical practice; however, advancements in adolescent CHR-P populations are less established. METHODS We performed a PRISMA/MOOSE-compliant systematic review of the Web of Science database, from inception until 7 October 2019, to identify original studies conducted in CHR-P children and adolescents (mean age <18 years). Findings were systematically appraised around core themes: detection, prognosis and intervention. We performed meta-analyses (employing Q statistics and I 2 test) regarding the proportion of CHR-P subgroups, the prevalence of baseline comorbid mental disorders, the risk of psychosis onset and the type of interventions received at baseline. Quality assessment and publication bias were also analysed. RESULTS Eighty-seven articles were included (n = 4,667 CHR-P individuals). Quality of studies ranged from 3.5 to 8 (median 5.5) on a modified Newcastle-Ottawa scale. Detection: Individuals were aged 15.6 ± 1.2 years (51.5% males), mostly (83%) presenting with attenuated positive psychotic symptoms. CHR-P psychometric accuracy improved when caregivers served as additional informants. Comorbid mood (46.4%) and anxiety (31.4%) disorders were highly prevalent. Functioning and cognition were impaired. Neurobiological studies were inconclusive. PROGNOSIS Risk for psychosis was 10.4% (95%CI: 5.8%-18.1%) at 6 months, 20% (95%CI: 15%-26%) at 12 months, 23% (95%CI: 18%-29%) at 24 months and 23.3% (95%CI: 17.3%-30.7%) at ≥36 months. INTERVENTIONS There was not enough evidence to recommend one specific treatment (including cognitive behavioural therapy) over the others (including control conditions) to prevent the transition to psychosis in this population. Randomised controlled trials suggested that family interventions, cognitive remediation and fish oil supplementation may improve cognition, symptoms and functioning. At baseline, 30% of CHR-P adolescents were prescribed antipsychotics and 60% received psychotherapy. CONCLUSIONS It is possible to detect and formulate a group-level prognosis in adolescents at risk for psychosis. Future interventional research is required.
Collapse
Affiliation(s)
- Ana Catalan
- Mental Health Department - Biocruces Bizkaia Health Research Institute, Basurto University Hospital, Faculty of Medicine and Dentistry, University of the Basque Country - UPV/EHU, Biscay, Spain.,Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Gonzalo Salazar de Pablo
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón School of Medicine, IiSGM, CIBERSAM, Complutense University of Madrid, Madrid, Spain
| | - Julio Vaquerizo Serrano
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón School of Medicine, IiSGM, CIBERSAM, Complutense University of Madrid, Madrid, Spain
| | - Pierluca Mosillo
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,Faculty of Medicine and Surgery, University of Pavia, Pavia, Italy
| | - Helen Baldwin
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Aranzazu Fernández-Rivas
- Mental Health Department - Biocruces Bizkaia Health Research Institute, Basurto University Hospital, Faculty of Medicine and Dentistry, University of the Basque Country - UPV/EHU, Biscay, Spain
| | - Carmen Moreno
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón School of Medicine, IiSGM, CIBERSAM, Complutense University of Madrid, Madrid, Spain
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón School of Medicine, IiSGM, CIBERSAM, Complutense University of Madrid, Madrid, Spain
| | - Christoph U Correll
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA.,Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/ Northwell, Hempstead, NY, USA.,Center for Psychiatric Neuroscience, The Feinstein Institutes for Medical Research, Manhasset, NY, USA.,Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Ilaria Bonoldi
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,OASIS service, South London and Maudsley NHS Foundation Trust, London, UK.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,National Institute for Health Research, Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| |
Collapse
|
5
|
Perkins DO, Olde Loohuis L, Barbee J, Ford J, Jeffries CD, Addington J, Bearden CE, Cadenhead KS, Cannon TD, Cornblatt BA, Mathalon DH, McGlashan TH, Seidman LJ, Tsuang M, Walker EF, Woods SW. Polygenic Risk Score Contribution to Psychosis Prediction in a Target Population of Persons at Clinical High Risk. Am J Psychiatry 2020; 177:155-163. [PMID: 31711302 PMCID: PMC7202227 DOI: 10.1176/appi.ajp.2019.18060721] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The 2-year risk of psychosis in persons who meet research criteria for a high-risk syndrome is about 15%-25%; improvements in risk prediction accuracy would benefit the development and implementation of preventive interventions. The authors sought to assess polygenic risk score (PRS) prediction of subsequent psychosis in persons at high risk and to determine the impact of adding the PRS to a previously validated psychosis risk calculator. METHODS Persons meeting research criteria for psychosis high risk (N=764) and unaffected individuals (N=279) were followed for up to 2 years. The PRS was based on the latest schizophrenia and bipolar genome-wide association studies. Variables in the psychosis risk calculator included stressful life events, trauma, disordered thought content, verbal learning, information processing speed, and family history of psychosis. RESULTS For Europeans, the PRS varied significantly by group and was higher in the psychosis converter group compared with both the nonconverter and unaffected groups, but was similar for the nonconverter group compared with the unaffected group. For non-Europeans, the PRS varied significantly by group; the difference between the converters and nonconverters was not significant, but the PRS was significantly higher in converters than in unaffected individuals, and it did not differ between nonconverters and unaffected individuals. The R2liability (R2 adjusted for the rate of disease risk in the population being studied, here assuming a 2-year psychosis risk between 10% and 30%) for Europeans varied between 9.2% and 12.3% and for non-Europeans between 3.5% and 4.8%. The amount of risk prediction information contributed by the addition of the PRS to the risk calculator was less than severity of disordered thoughts and similar to or greater than for other variables. For Europeans, the PRS was correlated with risk calculator variables of information processing speed and verbal memory. CONCLUSIONS The PRS discriminates psychosis converters from nonconverters and modestly improves individualized psychosis risk prediction when added to a psychosis risk calculator. The schizophrenia PRS shows promise in enhancing risk prediction in persons at high risk for psychosis, although its potential utility is limited by poor performance in persons of non-European ancestry.
Collapse
Affiliation(s)
- Diana O Perkins
- Department of Psychiatry (Perkins, Barbee), Lineberger Bioinformatics Core (Ford), Renaissance Computing Institute (Jeffries), University of North Carolina, Chapel Hill; Center for Neurobehavioral Genetics (Olde Loohuis) and Departments of Psychiatry and Biobehavioral Sciences and Psychology (Bearden), University of California, Los Angeles; Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Alberta, Canada (Addington); Department of Psychiatry (Cadenhead) and Center for Behavioral Genomics, Department of Psychiatry (Tsuang), University of California, San Diego; Department of Psychology, Yale University, New Haven, Conn. (Cannon); Department of Psychiatry, Zucker Hillside Hospital, Glen Oaks, N.Y. (Cornblatt); Department of Psychiatry, University of California, San Francisco (Mathalon); Department of Psychiatry, Yale University, New Haven, Conn. (McGlashan, Woods); Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts General Hospital, Boston (Seidman); and Departments of Psychology and Psychiatry, Emory University, Atlanta (Walker)
| | - Loes Olde Loohuis
- Department of Psychiatry (Perkins, Barbee), Lineberger Bioinformatics Core (Ford), Renaissance Computing Institute (Jeffries), University of North Carolina, Chapel Hill; Center for Neurobehavioral Genetics (Olde Loohuis) and Departments of Psychiatry and Biobehavioral Sciences and Psychology (Bearden), University of California, Los Angeles; Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Alberta, Canada (Addington); Department of Psychiatry (Cadenhead) and Center for Behavioral Genomics, Department of Psychiatry (Tsuang), University of California, San Diego; Department of Psychology, Yale University, New Haven, Conn. (Cannon); Department of Psychiatry, Zucker Hillside Hospital, Glen Oaks, N.Y. (Cornblatt); Department of Psychiatry, University of California, San Francisco (Mathalon); Department of Psychiatry, Yale University, New Haven, Conn. (McGlashan, Woods); Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts General Hospital, Boston (Seidman); and Departments of Psychology and Psychiatry, Emory University, Atlanta (Walker)
| | - Jenna Barbee
- Department of Psychiatry (Perkins, Barbee), Lineberger Bioinformatics Core (Ford), Renaissance Computing Institute (Jeffries), University of North Carolina, Chapel Hill; Center for Neurobehavioral Genetics (Olde Loohuis) and Departments of Psychiatry and Biobehavioral Sciences and Psychology (Bearden), University of California, Los Angeles; Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Alberta, Canada (Addington); Department of Psychiatry (Cadenhead) and Center for Behavioral Genomics, Department of Psychiatry (Tsuang), University of California, San Diego; Department of Psychology, Yale University, New Haven, Conn. (Cannon); Department of Psychiatry, Zucker Hillside Hospital, Glen Oaks, N.Y. (Cornblatt); Department of Psychiatry, University of California, San Francisco (Mathalon); Department of Psychiatry, Yale University, New Haven, Conn. (McGlashan, Woods); Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts General Hospital, Boston (Seidman); and Departments of Psychology and Psychiatry, Emory University, Atlanta (Walker)
| | - John Ford
- Department of Psychiatry (Perkins, Barbee), Lineberger Bioinformatics Core (Ford), Renaissance Computing Institute (Jeffries), University of North Carolina, Chapel Hill; Center for Neurobehavioral Genetics (Olde Loohuis) and Departments of Psychiatry and Biobehavioral Sciences and Psychology (Bearden), University of California, Los Angeles; Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Alberta, Canada (Addington); Department of Psychiatry (Cadenhead) and Center for Behavioral Genomics, Department of Psychiatry (Tsuang), University of California, San Diego; Department of Psychology, Yale University, New Haven, Conn. (Cannon); Department of Psychiatry, Zucker Hillside Hospital, Glen Oaks, N.Y. (Cornblatt); Department of Psychiatry, University of California, San Francisco (Mathalon); Department of Psychiatry, Yale University, New Haven, Conn. (McGlashan, Woods); Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts General Hospital, Boston (Seidman); and Departments of Psychology and Psychiatry, Emory University, Atlanta (Walker)
| | - Clark D Jeffries
- Department of Psychiatry (Perkins, Barbee), Lineberger Bioinformatics Core (Ford), Renaissance Computing Institute (Jeffries), University of North Carolina, Chapel Hill; Center for Neurobehavioral Genetics (Olde Loohuis) and Departments of Psychiatry and Biobehavioral Sciences and Psychology (Bearden), University of California, Los Angeles; Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Alberta, Canada (Addington); Department of Psychiatry (Cadenhead) and Center for Behavioral Genomics, Department of Psychiatry (Tsuang), University of California, San Diego; Department of Psychology, Yale University, New Haven, Conn. (Cannon); Department of Psychiatry, Zucker Hillside Hospital, Glen Oaks, N.Y. (Cornblatt); Department of Psychiatry, University of California, San Francisco (Mathalon); Department of Psychiatry, Yale University, New Haven, Conn. (McGlashan, Woods); Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts General Hospital, Boston (Seidman); and Departments of Psychology and Psychiatry, Emory University, Atlanta (Walker)
| | - Jean Addington
- Department of Psychiatry (Perkins, Barbee), Lineberger Bioinformatics Core (Ford), Renaissance Computing Institute (Jeffries), University of North Carolina, Chapel Hill; Center for Neurobehavioral Genetics (Olde Loohuis) and Departments of Psychiatry and Biobehavioral Sciences and Psychology (Bearden), University of California, Los Angeles; Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Alberta, Canada (Addington); Department of Psychiatry (Cadenhead) and Center for Behavioral Genomics, Department of Psychiatry (Tsuang), University of California, San Diego; Department of Psychology, Yale University, New Haven, Conn. (Cannon); Department of Psychiatry, Zucker Hillside Hospital, Glen Oaks, N.Y. (Cornblatt); Department of Psychiatry, University of California, San Francisco (Mathalon); Department of Psychiatry, Yale University, New Haven, Conn. (McGlashan, Woods); Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts General Hospital, Boston (Seidman); and Departments of Psychology and Psychiatry, Emory University, Atlanta (Walker)
| | - Carrie E Bearden
- Department of Psychiatry (Perkins, Barbee), Lineberger Bioinformatics Core (Ford), Renaissance Computing Institute (Jeffries), University of North Carolina, Chapel Hill; Center for Neurobehavioral Genetics (Olde Loohuis) and Departments of Psychiatry and Biobehavioral Sciences and Psychology (Bearden), University of California, Los Angeles; Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Alberta, Canada (Addington); Department of Psychiatry (Cadenhead) and Center for Behavioral Genomics, Department of Psychiatry (Tsuang), University of California, San Diego; Department of Psychology, Yale University, New Haven, Conn. (Cannon); Department of Psychiatry, Zucker Hillside Hospital, Glen Oaks, N.Y. (Cornblatt); Department of Psychiatry, University of California, San Francisco (Mathalon); Department of Psychiatry, Yale University, New Haven, Conn. (McGlashan, Woods); Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts General Hospital, Boston (Seidman); and Departments of Psychology and Psychiatry, Emory University, Atlanta (Walker)
| | - Kristin S Cadenhead
- Department of Psychiatry (Perkins, Barbee), Lineberger Bioinformatics Core (Ford), Renaissance Computing Institute (Jeffries), University of North Carolina, Chapel Hill; Center for Neurobehavioral Genetics (Olde Loohuis) and Departments of Psychiatry and Biobehavioral Sciences and Psychology (Bearden), University of California, Los Angeles; Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Alberta, Canada (Addington); Department of Psychiatry (Cadenhead) and Center for Behavioral Genomics, Department of Psychiatry (Tsuang), University of California, San Diego; Department of Psychology, Yale University, New Haven, Conn. (Cannon); Department of Psychiatry, Zucker Hillside Hospital, Glen Oaks, N.Y. (Cornblatt); Department of Psychiatry, University of California, San Francisco (Mathalon); Department of Psychiatry, Yale University, New Haven, Conn. (McGlashan, Woods); Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts General Hospital, Boston (Seidman); and Departments of Psychology and Psychiatry, Emory University, Atlanta (Walker)
| | - Tyrone D Cannon
- Department of Psychiatry (Perkins, Barbee), Lineberger Bioinformatics Core (Ford), Renaissance Computing Institute (Jeffries), University of North Carolina, Chapel Hill; Center for Neurobehavioral Genetics (Olde Loohuis) and Departments of Psychiatry and Biobehavioral Sciences and Psychology (Bearden), University of California, Los Angeles; Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Alberta, Canada (Addington); Department of Psychiatry (Cadenhead) and Center for Behavioral Genomics, Department of Psychiatry (Tsuang), University of California, San Diego; Department of Psychology, Yale University, New Haven, Conn. (Cannon); Department of Psychiatry, Zucker Hillside Hospital, Glen Oaks, N.Y. (Cornblatt); Department of Psychiatry, University of California, San Francisco (Mathalon); Department of Psychiatry, Yale University, New Haven, Conn. (McGlashan, Woods); Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts General Hospital, Boston (Seidman); and Departments of Psychology and Psychiatry, Emory University, Atlanta (Walker)
| | - Barbara A Cornblatt
- Department of Psychiatry (Perkins, Barbee), Lineberger Bioinformatics Core (Ford), Renaissance Computing Institute (Jeffries), University of North Carolina, Chapel Hill; Center for Neurobehavioral Genetics (Olde Loohuis) and Departments of Psychiatry and Biobehavioral Sciences and Psychology (Bearden), University of California, Los Angeles; Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Alberta, Canada (Addington); Department of Psychiatry (Cadenhead) and Center for Behavioral Genomics, Department of Psychiatry (Tsuang), University of California, San Diego; Department of Psychology, Yale University, New Haven, Conn. (Cannon); Department of Psychiatry, Zucker Hillside Hospital, Glen Oaks, N.Y. (Cornblatt); Department of Psychiatry, University of California, San Francisco (Mathalon); Department of Psychiatry, Yale University, New Haven, Conn. (McGlashan, Woods); Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts General Hospital, Boston (Seidman); and Departments of Psychology and Psychiatry, Emory University, Atlanta (Walker)
| | - Daniel H Mathalon
- Department of Psychiatry (Perkins, Barbee), Lineberger Bioinformatics Core (Ford), Renaissance Computing Institute (Jeffries), University of North Carolina, Chapel Hill; Center for Neurobehavioral Genetics (Olde Loohuis) and Departments of Psychiatry and Biobehavioral Sciences and Psychology (Bearden), University of California, Los Angeles; Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Alberta, Canada (Addington); Department of Psychiatry (Cadenhead) and Center for Behavioral Genomics, Department of Psychiatry (Tsuang), University of California, San Diego; Department of Psychology, Yale University, New Haven, Conn. (Cannon); Department of Psychiatry, Zucker Hillside Hospital, Glen Oaks, N.Y. (Cornblatt); Department of Psychiatry, University of California, San Francisco (Mathalon); Department of Psychiatry, Yale University, New Haven, Conn. (McGlashan, Woods); Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts General Hospital, Boston (Seidman); and Departments of Psychology and Psychiatry, Emory University, Atlanta (Walker)
| | - Thomas H McGlashan
- Department of Psychiatry (Perkins, Barbee), Lineberger Bioinformatics Core (Ford), Renaissance Computing Institute (Jeffries), University of North Carolina, Chapel Hill; Center for Neurobehavioral Genetics (Olde Loohuis) and Departments of Psychiatry and Biobehavioral Sciences and Psychology (Bearden), University of California, Los Angeles; Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Alberta, Canada (Addington); Department of Psychiatry (Cadenhead) and Center for Behavioral Genomics, Department of Psychiatry (Tsuang), University of California, San Diego; Department of Psychology, Yale University, New Haven, Conn. (Cannon); Department of Psychiatry, Zucker Hillside Hospital, Glen Oaks, N.Y. (Cornblatt); Department of Psychiatry, University of California, San Francisco (Mathalon); Department of Psychiatry, Yale University, New Haven, Conn. (McGlashan, Woods); Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts General Hospital, Boston (Seidman); and Departments of Psychology and Psychiatry, Emory University, Atlanta (Walker)
| | - Larry J Seidman
- Department of Psychiatry (Perkins, Barbee), Lineberger Bioinformatics Core (Ford), Renaissance Computing Institute (Jeffries), University of North Carolina, Chapel Hill; Center for Neurobehavioral Genetics (Olde Loohuis) and Departments of Psychiatry and Biobehavioral Sciences and Psychology (Bearden), University of California, Los Angeles; Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Alberta, Canada (Addington); Department of Psychiatry (Cadenhead) and Center for Behavioral Genomics, Department of Psychiatry (Tsuang), University of California, San Diego; Department of Psychology, Yale University, New Haven, Conn. (Cannon); Department of Psychiatry, Zucker Hillside Hospital, Glen Oaks, N.Y. (Cornblatt); Department of Psychiatry, University of California, San Francisco (Mathalon); Department of Psychiatry, Yale University, New Haven, Conn. (McGlashan, Woods); Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts General Hospital, Boston (Seidman); and Departments of Psychology and Psychiatry, Emory University, Atlanta (Walker)
| | - Ming Tsuang
- Department of Psychiatry (Perkins, Barbee), Lineberger Bioinformatics Core (Ford), Renaissance Computing Institute (Jeffries), University of North Carolina, Chapel Hill; Center for Neurobehavioral Genetics (Olde Loohuis) and Departments of Psychiatry and Biobehavioral Sciences and Psychology (Bearden), University of California, Los Angeles; Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Alberta, Canada (Addington); Department of Psychiatry (Cadenhead) and Center for Behavioral Genomics, Department of Psychiatry (Tsuang), University of California, San Diego; Department of Psychology, Yale University, New Haven, Conn. (Cannon); Department of Psychiatry, Zucker Hillside Hospital, Glen Oaks, N.Y. (Cornblatt); Department of Psychiatry, University of California, San Francisco (Mathalon); Department of Psychiatry, Yale University, New Haven, Conn. (McGlashan, Woods); Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts General Hospital, Boston (Seidman); and Departments of Psychology and Psychiatry, Emory University, Atlanta (Walker)
| | - Elaine F Walker
- Department of Psychiatry (Perkins, Barbee), Lineberger Bioinformatics Core (Ford), Renaissance Computing Institute (Jeffries), University of North Carolina, Chapel Hill; Center for Neurobehavioral Genetics (Olde Loohuis) and Departments of Psychiatry and Biobehavioral Sciences and Psychology (Bearden), University of California, Los Angeles; Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Alberta, Canada (Addington); Department of Psychiatry (Cadenhead) and Center for Behavioral Genomics, Department of Psychiatry (Tsuang), University of California, San Diego; Department of Psychology, Yale University, New Haven, Conn. (Cannon); Department of Psychiatry, Zucker Hillside Hospital, Glen Oaks, N.Y. (Cornblatt); Department of Psychiatry, University of California, San Francisco (Mathalon); Department of Psychiatry, Yale University, New Haven, Conn. (McGlashan, Woods); Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts General Hospital, Boston (Seidman); and Departments of Psychology and Psychiatry, Emory University, Atlanta (Walker)
| | - Scott W Woods
- Department of Psychiatry (Perkins, Barbee), Lineberger Bioinformatics Core (Ford), Renaissance Computing Institute (Jeffries), University of North Carolina, Chapel Hill; Center for Neurobehavioral Genetics (Olde Loohuis) and Departments of Psychiatry and Biobehavioral Sciences and Psychology (Bearden), University of California, Los Angeles; Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Alberta, Canada (Addington); Department of Psychiatry (Cadenhead) and Center for Behavioral Genomics, Department of Psychiatry (Tsuang), University of California, San Diego; Department of Psychology, Yale University, New Haven, Conn. (Cannon); Department of Psychiatry, Zucker Hillside Hospital, Glen Oaks, N.Y. (Cornblatt); Department of Psychiatry, University of California, San Francisco (Mathalon); Department of Psychiatry, Yale University, New Haven, Conn. (McGlashan, Woods); Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts General Hospital, Boston (Seidman); and Departments of Psychology and Psychiatry, Emory University, Atlanta (Walker)
| |
Collapse
|
6
|
Salazar de Pablo G, Guinart D, Cornblatt BA, Auther AM, Carrión RE, Carbon M, Jiménez-Fernández S, Vernal DL, Walitza S, Gerstenberg M, Saba R, Lo Cascio N, Brandizzi M, Arango C, Moreno C, Van Meter A, Fusar-Poli P, Correll CU. DSM-5 Attenuated Psychosis Syndrome in Adolescents Hospitalized With Non-psychotic Psychiatric Disorders. Front Psychiatry 2020; 11:568982. [PMID: 33192693 PMCID: PMC7609900 DOI: 10.3389/fpsyt.2020.568982] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 09/14/2020] [Indexed: 12/26/2022] Open
Abstract
Introduction: Although attenuated psychotic symptoms often occur for the first time during adolescence, studies focusing on adolescents are scarce. Attenuated psychotic symptoms form the criteria to identify individuals at increased clinical risk of developing psychosis. The study of individuals with these symptoms has led to the release of the DSM-5 diagnosis of Attenuated Psychosis Syndrome (APS) as a condition for further research. We aimed to characterize and compare hospitalized adolescents with DSM-5-APS diagnosis vs. hospitalized adolescents without a DSM-5-APS diagnosis. Methods: Interviewing help-seeking, hospitalized adolescents (aged 12-18 years) and their caregivers independently with established research instruments, we (1) evaluated the presence of APS among non-psychotic adolescents, (2) characterized and compared APS and non-APS individuals regarding sociodemographic, illness and intervention characteristics, (3) correlated psychopathology with levels of functioning and severity of illness and (4) investigated the influence of individual clinical, functional and comorbidity variables on the likelihood of participants to be diagnosed with APS. Results: Among 248 consecutively recruited adolescents (age=15.4 ± 1.5 years, females = 69.6%) with non-psychotic psychiatric disorders, 65 (26.2%) fulfilled APS criteria and 183 (73.8%) did not fulfill them. Adolescents with APS had higher number of psychiatric disorders than non-APS adolescents (3.5 vs. 2.4, p < 0.001; Cohen's d = 0.77), particularly, disruptive behavior disorders (Cramer's V = 0.16), personality disorder traits (Cramer's V = 0.26), anxiety disorders (Cramer's V = 0.15), and eating disorders (Cramer's V = 0.16). Adolescents with APS scored higher on positive (Cohen's d = 1.5), negative (Cohen's d = 0.55), disorganized (Cohen's d = 0.51), and general symptoms (Cohen's d = 0.84), and were more severely ill (Cohen's d = 1.0) and functionally impaired (Cohen's d = 0.31). Negative symptoms were associated with lower functional levels (Pearson ρ = -0.17 to -0.20; p = 0.014 to 0.031). Global illness severity was associated with higher positive, negative, and general symptoms (Pearson ρ = 0.22 to 0.46; p = 0.04 to p < 0.001). APS status was independently associated with perceptual abnormalities (OR = 2.0; 95% CI = 1.6-2.5, p < 0.001), number of psychiatric diagnoses (OR = 1.5; 95% CI = 1.2-2.0, p = 0.002), and impaired stress tolerance (OR = 1.4; 95% CI = 1.1-1.7, p = 0.002) (r 2 = 0.315, p < 0.001). Conclusions: A considerable number of adolescents hospitalized with non-psychotic psychiatric disorders meet DSM-5-APS criteria. These help-seeking adolescents have more comorbid disorders and more severe symptoms, functional impairment, and severity of illness than non-APS adolescents. Thus, they warrant high intensity clinical care.
Collapse
Affiliation(s)
- Gonzalo Salazar de Pablo
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.,Department of Child and Adolescent Psychiatry, Centro de Investigación Biomédica en Red de Salud Mental, General Universitario Gregorio Marañón School of Medicine, Institute of Psychiatry and Mental Health, Hospital Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense, Madrid, Spain
| | - Daniel Guinart
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States.,Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | - Barbara A Cornblatt
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States.,Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States.,Institute for Behavioral Science, The Feinstein Institutes for Medical Research, Manhasset, NY, United States
| | - Andrea M Auther
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States.,Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | - Ricardo E Carrión
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States.,Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States.,Institute for Behavioral Science, The Feinstein Institutes for Medical Research, Manhasset, NY, United States
| | - Maren Carbon
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States
| | - Sara Jiménez-Fernández
- Child and Adolescent Mental Health Unit, Jaén Medical Center, Jaén, Spain.,Department of Psychiatry, University of Granada, Granada, Spain
| | - Ditte L Vernal
- Research Unit for Child- and Adolescent Psychiatry, Aalborg University Hospital, Aalborg, Denmark
| | - Susanne Walitza
- Psychiatric University Hospital Zurich, Department of Child and Adolescent Psychiatry and Psychotherapy, Zurich, Switzerland
| | - Miriam Gerstenberg
- Psychiatric University Hospital Zurich, Department of Child and Adolescent Psychiatry and Psychotherapy, Zurich, Switzerland
| | | | - Nella Lo Cascio
- Prevention and Early Intervention Service, Department of Mental Health, Rome, Italy
| | - Martina Brandizzi
- Local Health Agency Rome 1, Santo Spirito in Sassia Hospital, Department of Mental Health, Inpatient Psychiatric Unit, Rome, Italy
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Centro de Investigación Biomédica en Red de Salud Mental, General Universitario Gregorio Marañón School of Medicine, Institute of Psychiatry and Mental Health, Hospital Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense, Madrid, Spain
| | - Carmen Moreno
- Department of Child and Adolescent Psychiatry, Centro de Investigación Biomédica en Red de Salud Mental, General Universitario Gregorio Marañón School of Medicine, Institute of Psychiatry and Mental Health, Hospital Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense, Madrid, Spain
| | - Anna Van Meter
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States.,Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States.,Institute for Behavioral Science, The Feinstein Institutes for Medical Research, Manhasset, NY, United States
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Outreach and Support in South London Service, South London and Maudsley National Health Service Foundation Trust, London, United Kingdom
| | - Christoph U Correll
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States.,Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States.,Institute for Behavioral Science, The Feinstein Institutes for Medical Research, Manhasset, NY, United States.,Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| |
Collapse
|
7
|
Millman ZB, Gold JM, Mittal VA, Schiffman J. The Critical Need for Help-Seeking Controls in Clinical High-Risk Research. Clin Psychol Sci 2019; 7:1171-1189. [PMID: 33614257 PMCID: PMC7891463 DOI: 10.1177/2167702619855660] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Despite rapidly growing knowledge of the clinical high-risk (CHR) state for psychosis, the vast majority of case-control studies have relied on healthy volunteers as a reference point for drawing inferences about the CHR construct. Researchers have long recognized that results generated from this design are limited by significant interpretive concerns, yet little attention has been given to how these concerns affect the growing field of CHR research. We argue that overreliance on healthy controls in CHR research threatens the validity of inferences concerning group differences, hinders advances in understanding the development of psychosis, and limits clinical progress. We suggest that the combined use of healthy and help-seeking (i.e., psychiatric) controls is a necessary step for the next generation of CHR research. We then evaluate methods for help-seeking control studies, identify the available CHR studies that have used such designs, discuss select findings in this literature, and offer recommendations for research.
Collapse
Affiliation(s)
| | - James M. Gold
- Maryland Psychiatric Research Center, University of Maryland School of Medicine
| | - Vijay A. Mittal
- Department of Psychology, Northwestern University
- Department of Psychiatry, Northwestern University
- Institute for Policy Research, Northwestern University
- Medical Social Sciences, Northwestern University
- Institute for Innovations in Developmental Sciences, Northwestern University
| | - Jason Schiffman
- Department of Psychology, University of Maryland, Baltimore County
| |
Collapse
|
8
|
Biagiarelli M, Curto M, Listanti G, Andraos MP, Pazzelli F, Aprile V, Pelaccia S, Mantovani B, Caccia F, Carpentieri R, Trabucchi G, Tambelli R, Girardi P, Ferracuti S, Baldessarini RJ, Sarlatto C. Efficacy of the Cooperative Assessment Method (COOPAS) to Improve the Psychiatric Care of Help-Seeking Adolescents. CLINICAL NEUROPSYCHIATRY 2019; 16:189-196. [PMID: 34908955 PMCID: PMC8650201 DOI: 10.36131/clinicalnpsych2019050601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objective Effective treatment of adolescents with psychopathological disorders is essential to reduce later morbidity and disability. To evaluate the clinical value of a new adolescent Cooperative Assessment scheme (COOPAS) as indicated by establishing therapeutic alliance, improving symptoms, and particularly by reducing dropouts. Method Consecutive help-seeking adolescents (N=136) were recruited, evaluated with an 8-week COOPAS protocol and followed for 6 months to document dropouts during treatment. Clinical rating scales [Hamilton Depression and Anxiety scales (HAM-D, HAM-A), Global Functioning Role and Social Scales (GF-RS, GF-SS), Structured Interview for Prodromal Symptoms (SIPS), Clinical Global Impression (CGI), Working Alliance Inventory-Therapist version (WAI-T), Therapist Response Questionnaire (TRQ), Psychotherapy Relationship Questionnaire (PRQ)] were administered at intake, 4 weeks later, and at the end of COOPAS evaluation (8 weeks). Results Final HAM-A and HAM-D scores improved by 25%; CGI, GF-SS and GF-RS also improved significantly. Similarly, WAI-T showed significant improvements in all three subscales, and patient-clinician relationships (PRQ) showed decreases in Anxious/Preoccupied and Avoidant/Counterdependent dimensions with increases of the Secure/Engaged measure. After 6 months, dropout rate was 8.82%. Conclusions COOPAS assessment was followed by reduced depressive and anxiety symptoms, good therapeutic alliance, and low dropout in adolescents.
Collapse
Affiliation(s)
- Mario Biagiarelli
- NESMOS Department (Neurosciences, Mental Health and Sensory Organs), Sant'Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy.,Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Italy
| | - Martina Curto
- Department of Human Neurosciences, Sapienza University of Rome, Italy.,International Consortium for Mood and Psychotic Disorders Research, Mailman Research Center, McLean Hospital, Belmont, Massachusetts, USA
| | - Giulia Listanti
- NESMOS Department (Neurosciences, Mental Health and Sensory Organs), Sant'Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
| | - Maria Paola Andraos
- NESMOS Department (Neurosciences, Mental Health and Sensory Organs), Sant'Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
| | - Floriana Pazzelli
- NESMOS Department (Neurosciences, Mental Health and Sensory Organs), Sant'Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
| | - Veronica Aprile
- NESMOS Department (Neurosciences, Mental Health and Sensory Organs), Sant'Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
| | - Simona Pelaccia
- NESMOS Department (Neurosciences, Mental Health and Sensory Organs), Sant'Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
| | - Beatrice Mantovani
- NESMOS Department (Neurosciences, Mental Health and Sensory Organs), Sant'Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
| | - Federica Caccia
- NESMOS Department (Neurosciences, Mental Health and Sensory Organs), Sant'Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
| | - Renato Carpentieri
- NESMOS Department (Neurosciences, Mental Health and Sensory Organs), Sant'Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
| | - Guido Trabucchi
- NESMOS Department (Neurosciences, Mental Health and Sensory Organs), Sant'Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
| | - Renata Tambelli
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Italy
| | - Paolo Girardi
- NESMOS Department (Neurosciences, Mental Health and Sensory Organs), Sant'Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
| | - Stefano Ferracuti
- Department of Human Neurosciences, Sapienza University of Rome, Italy
| | - Ross J Baldessarini
- International Consortium for Mood and Psychotic Disorders Research, Mailman Research Center, McLean Hospital, Belmont, Massachusetts, USA.,Department of Psychiatry, McLean Hospital, Harvard Medical School
| | - Cinzia Sarlatto
- NESMOS Department (Neurosciences, Mental Health and Sensory Organs), Sant'Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
| |
Collapse
|
9
|
Carrión RE, Auther AM, McLaughlin D, Olsen R, Addington J, Bearden CE, Cadenhead KS, Cannon TD, Mathalon DH, McGlashan TH, Perkins DO, Seidman LJ, Tsuang MT, Walker EF, Woods SW, Cornblatt BA. The Global Functioning: Social and Role Scales-Further Validation in a Large Sample of Adolescents and Young Adults at Clinical High Risk for Psychosis. Schizophr Bull 2019; 45:763-772. [PMID: 30351423 PMCID: PMC6581127 DOI: 10.1093/schbul/sby126] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Traditional measures for assessing functioning with adult patients with schizophrenia have been shown to be insufficient for assessing the issues that occur in adolescents and young adults at clinical high risk (CHR) for psychosis. The current study provides an expanded validation of the Global Functioning: Social (GF:Social) and Role (GF:Role) scales developed specifically for use with CHR individuals and explores the reliability and accuracy of the ratings, the validity of the scores in comparison to other established clinical measures, stability of functioning over a 2-year period, and psychosis predictive ability. METHODS Seven hundred fifty-five CHR individuals and 277 healthy control (HC) participants completed the GF:Social and Role scales at baseline as part of the North American Prodrome Longitudinal Study (NAPLS2). RESULTS Inter-rater reliability and accuracy were high for both scales. Correlations between the GF scores and other established clinical measures demonstrated acceptable convergent and discriminant validity. In addition, GF:Social and Role scores were unrelated to positive symptoms. CHR participants showed large impairments in social and role functioning over 2-years, relative to the HCs, even after adjusting for age, IQ, and attenuated positive symptoms. Finally, social decline prior to baseline was more pronounced in CHR converters, relative to non-converters. CONCLUSIONS The GF scales can be administered in a large-scale multi-site study with excellent inter-rater reliability and accuracy. CHR individuals showed social and role functioning impairments over time that were not confounded by positive symptom severity levels. The results of this study demonstrate that social decline is a particularly effective predictor of conversion outcome.
Collapse
Affiliation(s)
- Ricardo E Carrión
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY,Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY,Department of Psychiatry, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY,To whom correspondence should be addressed; Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, 75-59, 263rd Street, Glen Oaks, NY 11004, US; tel: 718-470-8878, fax: 718-470-8131, e-mail:
| | - Andrea M Auther
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY,Department of Psychiatry, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Danielle McLaughlin
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY
| | - Ruth Olsen
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY
| | - Jean Addington
- Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Carrie E Bearden
- Semel Institute for Neuroscience and Human Behavior and Department of Psychology, University of California, Los Angeles, Los Angeles, CA
| | | | - Tyrone D Cannon
- Department of Psychology, Yale University, School of Medicine, New Haven, CT,Department of Psychiatry, Yale University, School of Medicine, New Haven, CT
| | - Daniel H Mathalon
- Department of Psychiatry, University of California, San Francisco, CA
| | - Thomas H McGlashan
- Department of Psychiatry, Yale University, School of Medicine, New Haven, CT
| | - Diana O Perkins
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Larry J Seidman
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts General Hospital, Boston, MA
| | - Ming T Tsuang
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts General Hospital, Boston, MA
| | | | - Scott W Woods
- Department of Psychiatry, Yale University, School of Medicine, New Haven, CT
| | - Barbara A Cornblatt
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY,Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY,Department of Psychiatry, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY,Department of Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| |
Collapse
|
10
|
Molteni S, Filosi E, Mensi MM, Spada G, Zandrini C, Ferro F, Paoletti M, Pichiecchio A, Bonoldi I, Balottin U. Predictors of Outcomes in Adolescents With Clinical High Risk for Psychosis, Other Psychiatric Symptoms, and Psychosis: A Longitudinal Protocol Study. Front Psychiatry 2019; 10:787. [PMID: 31849719 PMCID: PMC6902080 DOI: 10.3389/fpsyt.2019.00787] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 10/02/2019] [Indexed: 02/01/2023] Open
Abstract
In children and adolescents, schizophrenia is one of the ten main causes of disability-adjusted life years. The identification of people at Clinical High Risk of developing Psychosis (CHR-P) is one of the most promising strategies to improve outcomes. However, in children and adolescents research on the CHR-P state is still in its infancy and the clinical validity of at-risk criteria appears understudied in this population. Furthermore, only few studies have evaluated the psychopathological, neuropsychological, neuroimaging characteristics and, especially, long-term outcomes of adolescents at high risk. We present here the protocol of an innovative longitudinal cohort study of adolescents aged 12-17. The sample will consist of patients admitted to a third level neuropsychiatric unit, belonging to one of the following three subgroups: 1) adolescents with established Diagnostic and Statistical Manual of Mental Disorder-Fifth Edition psychosis, 2) adolescents with CHR-P, and 3) adolescents with psychiatric symptoms other than established psychosis or CHR-P. The primary aim of our study is to evaluate the 2-year prognosis across the three groups. We will measure transition to psychosis (or the stability of the diagnosis of psychosis in the psychotic group), the risk of development of other psychiatric disorders, as well as socio-occupational functioning at outcome. The secondary aim will be to explore the effect of specific predictors (clinical, neuropsychological and neuroimaging factors) on the prognosis. At baseline, 1-year and 2-year follow-up participants will be assessed using standardized semi-structured interviews and instruments. Psychopathological and functioning variables, as well as neuropsychological domains will be compared across the three subgroups. Moreover, at baseline and 2-year follow-up all recruited patients will undergo a 3-Tesla magnetic resonance imaging examination and diffusion tensor imaging parameters will be analyzed. We believe that this study will advance our ability to predict outcomes in underage CHR-P samples. In particular, our data will enable a better understanding of the clinical significance of CHR-P in adolescents, and shed new light on prognostic factors that can be used to refine the prediction of clinical outcomes and the implementation of preventive interventions.
Collapse
Affiliation(s)
- Silvia Molteni
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Eleonora Filosi
- Child Neuropsychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Maria Martina Mensi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Child Neuropsychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Giulia Spada
- Institute of Psychiatry, Psychology and Neuroscience, King's College of London, London, United Kingdom
| | - Chiara Zandrini
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Federica Ferro
- Child Neuropsychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Matteo Paoletti
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Neuroradiology Department, IRCCS Mondino Foundation, Pavia, Italy
| | - Anna Pichiecchio
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Neuroradiology Department, IRCCS Mondino Foundation, Pavia, Italy
| | - Ilaria Bonoldi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Institute of Psychiatry, Psychology and Neuroscience, King's College of London, London, United Kingdom
| | - Umberto Balottin
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Child Neuropsychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| |
Collapse
|
11
|
Raballo A, Monducci E, Ferrara M, Fiori Nastro P, Dario C. Developmental vulnerability to psychosis: Selective aggregation of basic self-disturbance in early onset schizophrenia. Schizophr Res 2018; 201:367-372. [PMID: 29804931 DOI: 10.1016/j.schres.2018.05.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 05/06/2018] [Accepted: 05/12/2018] [Indexed: 11/29/2022]
Abstract
Trait-like anomalies of subjective experience (aka, Basic Self-disturbance or Self-disorder, SD) have been empirically identified as schizophrenia-specific markers of vulnerability in several clinical and genetic high-risk populations. However, such specificity is still to be tested in developmental years, where emerging psychopathology is less crystallized and diagnostic boundaries more blurred. Thus, the current study explores the distribution of SD in adolescent help-seekers (age range 14 to 18) and tests the specificity of SD with respect to the severity of their diagnostic staging (Early Onset schizophrenia-spectrum psychosis [EOP], ultra high-risk [UHR] and clinical help-seeking controls [CHSC]). For this purpose, 96 help-seeking adolescents consecutively referred to specialized Child and Adolescent Units for diagnostic evaluation, underwent a comprehensive psychopathological examination including the specific interview for SD (i.e. the Examination of Anomalous Self-Experience, EASE). One-way ANOVA was used to test the diagnostic distribution of SD (EASE score), whereas multinomial logistic regression was used to test the effect of SD on the diagnostic outcome. SD frequency (both in terms of EASE total score and domain sub-scores) was decreasing progressively from EOP to CHSC, with intermediate levels in UHR. The EASE total score increased the risk of belonging to the more severe diagnostic stages (i.e, UHR and EOP vs CHSC as reference class) and allowed the correct reclassification of the 75% of the sample. The results confirm the schizophrenia-spectrum specificity of SD in adolescence, highlighting their potential value for early differential diagnosis and risk stratification.
Collapse
Affiliation(s)
- Andrea Raballo
- Psychodiagnostic and Clinical Psychopharmacology Unit, Division of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, University of Perugia, Perugia, Italy; Psychopathology and Development Research Group, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
| | - Elena Monducci
- Department of Neurology and Psychiatry, "Sapienza" University of Rome, Rome, Italy
| | - Mauro Ferrara
- Pediatrics and Paediatric Neuropsychiatry, "Sapienza" University of Rome, Rome, Italy
| | - Paolo Fiori Nastro
- Department of Neurology and Psychiatry, "Sapienza" University of Rome, Rome, Italy
| | - Claudia Dario
- Department of Neurology and Psychiatry, "Sapienza" University of Rome, Rome, Italy; Psychiatric Center Hvidovre, University of Copenhagen, Denmark; Center for Subjectivity Research, University of Copenhagen, Denmark
| | | |
Collapse
|