1
|
Chester LA, Valmaggia LR, Kempton MJ, Chesney E, Oliver D, Hedges EP, Klatsa E, Stahl D, van der Gaag M, de Haan L, Nelson B, McGorry P, Amminger GP, Riecher-Rössler A, Studerus E, Bressan R, Barrantes-Vidal N, Krebs MO, Glenthøj B, Nordentoft M, Ruhrmann S, Sachs G, McGuire P. Influence of cannabis use on incidence of psychosis in people at clinical high risk. Psychiatry Clin Neurosci 2023; 77:469-477. [PMID: 37070555 PMCID: PMC7615575 DOI: 10.1111/pcn.13555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 03/15/2023] [Accepted: 03/30/2023] [Indexed: 04/19/2023]
Abstract
AIMS Evidence for case-control studies suggests that cannabis use is a risk factor for the development of psychosis. However, there have been limited prospective studies and the direction of this association remains controversial. The primary aim of the present study was to examine the association between cannabis use and the incidence of psychotic disorders in people at clinical high risk of psychosis. Secondary aims were to assess associations between cannabis use and the persistence of psychotic symptoms, and with functional outcome. METHODS Current and previous cannabis use were assessed in individuals at clinical high risk of psychosis (n = 334) and healthy controls (n = 67), using a modified version of the Cannabis Experience Questionnaire. Participants were assessed at baseline and followed up for 2 years. Transition to psychosis and persistence of psychotic symptoms were assessed using the Comprehensive Assessment of At-Risk Mental States criteria. Level of functioning at follow up was assessed using the Global Assessment of Functioning disability scale. RESULTS During follow up, 16.2% of the clinical high-risk sample developed psychosis. Of those who did not become psychotic, 51.4% had persistent symptoms and 48.6% were in remission. There was no significant association between any measure of cannabis use at baseline and either transition to psychosis, the persistence of symptoms, or functional outcome. CONCLUSIONS These findings contrast with epidemiological data that suggest that cannabis use increases the risk of psychotic disorder.
Collapse
Affiliation(s)
- Lucy A. Chester
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Lucia R. Valmaggia
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Matthew J. Kempton
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Edward Chesney
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Dominic Oliver
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- Department of Psychiatry, Oxford University, Warneford Hospital, Oxford, UK
| | - Emily P. Hedges
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Elise Klatsa
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Daniel Stahl
- Department of Biostatistics, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Mark van der Gaag
- Faculty of Behavioural and Movement Sciences, Department of Clinical Psychology and EMGO+ Institute for Health and Care Research, VU University, Amsterdam, The Netherlands
- Department of Psychosis Research, Parnassia Psychiatric Institute, The Hague, The Netherlands
| | - Lieuwe de Haan
- Department Early Psychosis, Amsterdam UMC, Amsterdam, The Netherlands
- Arkin Amsterdam, Amsterdam, The Netherlands
| | - Barnaby Nelson
- Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia
- Orygen, Parkville, Victoria, Australia
| | - Patrick McGorry
- Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia
- Orygen, Parkville, Victoria, Australia
| | - G. Paul Amminger
- Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia
- Orygen, Parkville, Victoria, Australia
| | | | - Erich Studerus
- Department of Psychology, Division of Personality and Developmental Psychology, University of Basel, Basel, Switzerland
| | - Rodrigo Bressan
- LiNC—Lab Interdisciplinar Neurociências Clínicas, Depto Psiquiatria, Escola Paulista de Medicina, Universidade Federal de São Paulo – UNIFESP, Sao Paulo, Brazil
| | - Neus Barrantes-Vidal
- Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Fundació, Sanitària Sant Pere Claver (Spain), Spanish Mental Health Research Network (CIBERSAM), Barcelona, Spain
| | - Marie-Odile Krebs
- Hôpital Sainte-Anne, C’JAAD, Service Hospitalo-Universitaire, Inserm U894, Institut de Psychiatrie (CNRS 3557), University Paris Descartes, Paris, France
| | - Birte Glenthøj
- Centre for Neuropsychiatric Schizophrenia Research (CNSR) & Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Centre Glostrup, University of Copenhagen, Glostrup, Denmark
| | - Merete Nordentoft
- Mental Health Center Copenhagen and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Mental Health Center Glostrup, Mental Health Services in the Capital Region of Copenhagen, University of Copenhagen, Kobenhavn, Denmark
| | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Gabriele Sachs
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Wien, Austria
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- Department of Psychiatry, Oxford University, Warneford Hospital, Oxford, UK
| |
Collapse
|
2
|
Wei Y, Liu J, Zhang T, Su W, Tang X, Tang Y, Xu L, Qian Z, Zhang T, Li X, Wang J. Reduced interpersonal neural synchronization in right inferior frontal gyrus during social interaction in participants with clinical high risk of psychosis: An fNIRS-based hyperscanning study. Prog Neuropsychopharmacol Biol Psychiatry 2023; 120:110634. [PMID: 36099966 DOI: 10.1016/j.pnpbp.2022.110634] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 08/28/2022] [Accepted: 09/05/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Clinical high risk (CHR) of psychosis is characterized by cognitive impairment in social interaction. However, research investigating the neurobiological underpinnings of social interactions and interpersonal relationships in CHR participants is sparse. METHODS 21 CHR and 54 healthy controls (HCs) participated in the study. Dyads were formed between one CHR, one sex-matched HC, and two sex-matched HCs comprising 19 CHR-HC dyads and 19 HC-HC dyads. The concentration changes of oxyhemoglobin and deoxyhemoglobin were examined during a two-block button-press "cooperation" and "competition" task using functional near-infrared spectroscopy(fNIRS) hyperscanning technology. CHR diagnosis and psychopathological assessments were performed by Structured Interview for Prodromal Syndromes (SIPS) and Scale of Prodromal Symptoms (SOPS). Neural synchronizations were compared between CHR-HC dyads and HC-HC dyads. Correlation analyses were performed to identify the relationship between neural synchronization, clinical syndrome and cognition. RESULTS During the cooperation, but not the competition task, the CHR-HC dyads showed reduced inter-brain neural synchronization (INS) in the right inferior frontal gyrus (IFG) compared to the HC-HC dyads. INS also showed a positive correlation with the average cooperation rate. Moreover, the reduced INS in the CHR-HC group was significantly correlated with symptoms score of suspiciousness/persecutory ideas and movement disorders. CONCLUSIONS The decreased INS in right IFG during cooperation could account for CHR's cognitive impairment of social interaction. Our findings provide evidence that inter-brain neural synchronization potentially represents a biomarker of social interaction deficits of CHR.
Collapse
Affiliation(s)
- Yanyan Wei
- Shanghai Key Laboratory of Psychotic Disorder, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Jieqiong Liu
- Pediatric Translational Medicine Institute, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Tingyu Zhang
- Affiliated Mental Health Center (ECNU), School of Psychology and Cognitive Science, East China Normal University, Shanghai, 200062, China
| | - Wenjun Su
- Shanghai Key Laboratory of Psychotic Disorder, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Xiaochen Tang
- Shanghai Key Laboratory of Psychotic Disorder, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Yingying Tang
- Shanghai Key Laboratory of Psychotic Disorder, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Lihua Xu
- Shanghai Key Laboratory of Psychotic Disorder, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Zhenying Qian
- Shanghai Key Laboratory of Psychotic Disorder, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Tianhong Zhang
- Shanghai Key Laboratory of Psychotic Disorder, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China.
| | - Xianchun Li
- Shanghai Key Laboratory of Mental Health and Psychological Crisis Intervention, Affiliated Mental Health Center (ECNU), School of Psychology and Cognitive Science, East China Normal University, Shanghai, 200062, China; Shanghai Changning Mental Health Center, Shanghai, 200335, China; Institute of Wisdom in China, East China Normal University, Shanghai, 200062, China.
| | - Jijun Wang
- Shanghai Key Laboratory of Psychotic Disorder, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China.
| |
Collapse
|
3
|
Effect of cognitive insight on clinical insight from pre-morbid to early psychosis stages. Psychiatry Res 2022; 313:114613. [PMID: 35569423 DOI: 10.1016/j.psychres.2022.114613] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 04/12/2022] [Accepted: 04/16/2022] [Indexed: 11/20/2022]
Abstract
Poor cognitive insight, including low self-reflectiveness and high self-certainty, contributes to poor clinical insight, which includes awareness of illness, relabelling of specific symptoms, and treatment compliance. However, inconsistent results regarding cognitive insight among individuals at clinical high risk of psychosis (CHR) have been reported. This study investigated the difference in cognitive insight among groups with different severity of positive symptoms and analysed the effect of cognitive insight on clinical insight in each group. All participants, including CHR individuals with 3 or 4 points (L-Pitem, n = 85) and 5 points (H-Pitem, n = 37) on any positive-symptom item of the Scale of Prodromal Syndromes, and patients with first-episode psychosis (FEP, n = 59), were measured cognitive and clinical insight using the Beck Cognitive Insight Scale and the Schedule of Assessment of Insight, respectively. The self-reflectiveness of cognitive insight was highest in the L-Pitem group and lowest in the FEP group. Self-reflectiveness was positively associated with awareness of illness in the L-Pitem and FEP groups; both self-reflectiveness and self-certainty was positively associated with treatment compliance in the L-Pitem group. Improving self-reflectiveness of cognitive insight may conduce to good clinical insight. Self-certainty may have different implication to individuals with mild prodromal symptoms.
Collapse
|
4
|
Dondé C, Laprévote V, Lavallé L, Haesebaert F, Fakra E, Brunelin J. Cognitive insight in individuals with an at-risk mental state for psychosis: A meta-analysis. Early Interv Psychiatry 2021; 15:449-456. [PMID: 32452629 DOI: 10.1111/eip.12993] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 01/09/2020] [Accepted: 04/28/2020] [Indexed: 01/01/2023]
Abstract
AIM To compare cognitive insight abilities measured with the Beck Cognitive Insight Scale (BCIS) between individuals with an at-risk mental state (ARMS) and healthy controls. METHOD Review and meta-analysis based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS A search for articles investigating cognitive insight in ARMS in the MEDLINE and ScienceDirect databases revealed five studies including 303 ARMS and 376 controls. Regarding BCIS subscales, ARMS individuals displayed significant higher scores for self-certainty than controls with a small-to-moderate effect size (ESg = 0.45 [0.23;0.67], P < .005), whereas no significant difference was observed for self-reflectiveness (ESg = -0.56 [-0.18;1.29], P = .14). No significant differences were observed between ARMS and controls for overall cognitive insight abilities as indexed by the BCIS composite score (ESg = -0.24 [-0.43;0.91], P = .45). CONCLUSIONS Self-certainty abnormalities seem to predate the expression of full-blown psychotic episode and to be higher in ARMS than in healthy controls. By contrast, ARMS did not display abnormal self-reflectiveness and overall cognitive insight abilities.
Collapse
Affiliation(s)
- Clément Dondé
- INSERM, U1028; CNRS, UMR5292; Lyon Neuroscience Research Center, Psychiatric Disorders: from Resistance to Response, PSYR2 Team, Lyon, France.,University Lyon 1, Villeurbanne, France.,Centre Hospitalier Le Vinatier, Bron, France
| | - Vincent Laprévote
- Pôle Hospitalo-Universitaire de Psychiatrie d'Adultes du Grand Nancy, Centre Psychothérapique de Nancy, Laxou, France.,INSERM U1114, Fédération de Médecine Translationnelle de Strasbourg, Département de Psychiatrie, Centre Hospitalier Régional Universitaire de Strasbourg, Strasbourg, France.,Faculté de Médecine, Université de Lorraine, Nancy, France
| | - Layla Lavallé
- INSERM, U1028; CNRS, UMR5292; Lyon Neuroscience Research Center, Psychiatric Disorders: from Resistance to Response, PSYR2 Team, Lyon, France.,University Lyon 1, Villeurbanne, France.,Centre Hospitalier Le Vinatier, Bron, France
| | - Frédéric Haesebaert
- INSERM, U1028; CNRS, UMR5292; Lyon Neuroscience Research Center, Psychiatric Disorders: from Resistance to Response, PSYR2 Team, Lyon, France.,University Lyon 1, Villeurbanne, France.,Centre Hospitalier Le Vinatier, Bron, France
| | - Eric Fakra
- INSERM, U1028; CNRS, UMR5292; Lyon Neuroscience Research Center, Psychiatric Disorders: from Resistance to Response, PSYR2 Team, Lyon, France.,Department of Psychiatry, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Jerome Brunelin
- INSERM, U1028; CNRS, UMR5292; Lyon Neuroscience Research Center, Psychiatric Disorders: from Resistance to Response, PSYR2 Team, Lyon, France.,University Lyon 1, Villeurbanne, France.,Centre Hospitalier Le Vinatier, Bron, France
| |
Collapse
|
5
|
Murray RM, David AS, Ajnakina O. Prevention of psychosis: moving on from the at-risk mental state to universal primary prevention. Psychol Med 2021; 51:223-227. [PMID: 32892760 PMCID: PMC7893507 DOI: 10.1017/s003329172000313x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 04/09/2020] [Accepted: 08/12/2020] [Indexed: 12/14/2022]
Abstract
The value of services for those with the 'At Risk Mental State for Psychosis' (ARMS) continues to be disputed. ARMS services have provided a valuable stimulus to academic research into the transition into psychosis. Furthermore, there is currently a welcome trend to transform such clinics into youth mental health services catering for the broader clientele of young people suffering from anxiety and depression, who already constitute the bulk of those seen at ARMS clinics. However, such services are never likely to make major inroads into preventing psychosis because they only reach a small proportion of those at risk. Evidence from medicine shows that avoiding exposure to factors which increase the risk of disease (e.g. poor nutrition, transmission of infection, tobacco smoking), produces greater public benefit than focussing efforts on individuals with, or about to develop, disease. We consider that the most productive approach for psychosis prevention is avoiding exposure to risk-increasing factors. The best-established risk factors for psychosis are obstetric events, childhood abuse, migration, city living, adverse life events and cannabis use. Some as city living, are likely proxies for an unknown causal factor(s) while preventing others such as childhood abuse is currently beyond our powers. The risk factor for psychosis which is most readily open to this approach is the use of cannabis. Therefore, as an initial step towards a strategy for universal primary prevention, we advocate public health campaigns to educate young people about the harms of regular use of high potency cannabis.
Collapse
Affiliation(s)
- Robin M. Murray
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Psychiatry, Experimental Biomedicine and Clinical Neuroscience, University of Palermo, Palermo, Italy
| | - Anthony S. David
- Institute of Mental Health, University College London, London, UK
| | - Olesya Ajnakina
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, University of London, London, UK
| |
Collapse
|
6
|
Xu L, Zhang M, Wang S, Wei Y, Cui H, Qian Z, Wang Y, Tang X, Hu Y, Tang Y, Zhang T, Wang J. Relationship Between Cognitive and Clinical Insight at Different Durations of Untreated Attenuated Psychotic Symptoms in High-Risk Individuals. Front Psychiatry 2021; 12:753130. [PMID: 34867540 PMCID: PMC8637962 DOI: 10.3389/fpsyt.2021.753130] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 10/15/2021] [Indexed: 11/26/2022] Open
Abstract
Background: This study examines whether cognitive insight is impaired in high-risk individuals with attenuated psychotic symptoms (APS) and explores the relationship between cognitive and clinical insight at different durations of untreated attenuated psychotic symptoms (DUAPS). Methods: The Structured Interview for Psychosis high-risk Syndrome (SIPS) was used to identify APS individuals. APS (n = 121) and healthy control (HC, n = 87) subjects were asked to complete the Beck Cognitive Insight Scale (BCIS). Clinical insight of APS individuals was evaluated using the Schedule for Assessment of Insight (SAI). APS individuals were classified into four subgroups based on DUAPS, including 0-3, 4-6, 7-12, and >12 months. Power analysis for significant correlation was conducted using the WebPower package in R. Results: Compared with HC subjects, APS individuals showed poorer cognitive insight, with lower scores on BCIS self-reflectiveness and composite index (BCIS self-reflectiveness minus BCIS self-certainty). Only when DUAPS was longer than 12 months did the significant positive correlation between cognitive and clinical insight obtain the power about 0.8, including the associations between self-reflectiveness and awareness of illness, self-reflectiveness and the total clinical insight, and composite index and awareness of illness. The positive associations of composite index with awareness of illness within 0-3 months DUAPS and with the total score of SAI when DUAPS > 12 months were significant but failed to obtain satisfactory power. Conclusions: APS individuals may have impaired cognitive insight, demonstrating lower self-reflectiveness. The correlation between cognitive and clinical insight is associated with the duration of untreated attenuated psychotic symptoms.
Collapse
Affiliation(s)
- LiHua Xu
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Mei Zhang
- Department of Nursing and Midwifery, Jiangsu College of Nursing, Huai'an, China
| | - ShuQin Wang
- Department of Chinese Language Teaching, Shanghong Middle School, Shanghai, China
| | - YanYan Wei
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - HuiRu Cui
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - ZhenYing Qian
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - YingChan Wang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - XiaoChen Tang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - YeGang Hu
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - YingYing Tang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - TianHong Zhang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - JiJun Wang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, China.,CAS Center for Excellence in Brain Science and Intelligence Technology (CEBSIT), Chinese Academy of Science, Shanghai, China.,Institute of Psychology and Behavioral Science, Shanghai Jiao Tong University, Shanghai, China
| |
Collapse
|
7
|
Cho KKA, Davidson TJ, Bouvier G, Marshall JD, Schnitzer MJ, Sohal VS. Cross-hemispheric gamma synchrony between prefrontal parvalbumin interneurons supports behavioral adaptation during rule shift learning. Nat Neurosci 2020; 23:892-902. [PMID: 32451483 PMCID: PMC7347248 DOI: 10.1038/s41593-020-0647-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 04/22/2020] [Indexed: 12/11/2022]
Abstract
Organisms must learn new strategies to adapt to changing environments. Activity in different neurons often exhibits synchronization that can dynamically enhance their communication and might create flexible brain states that facilitate changes in behavior. We studied the role of gamma-frequency (~40 Hz) synchrony between prefrontal parvalbumin (PV) interneurons in mice learning multiple new cue-reward associations. Voltage indicators revealed cell-type-specific increases of cross-hemispheric gamma synchrony between PV interneurons when mice received feedback that previously learned associations were no longer valid. Disrupting this synchronization by delivering out-of-phase optogenetic stimulation caused mice to perseverate on outdated associations, an effect not reproduced by in-phase stimulation or out-of-phase stimulation at other frequencies. Gamma synchrony was specifically required when new associations used familiar cues that were previously irrelevant to behavioral outcomes, not when associations involved new cues or for reversing previously learned associations. Thus, gamma synchrony is indispensable for reappraising the behavioral salience of external cues.
Collapse
Affiliation(s)
- Kathleen K A Cho
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA
- Kavli Institute for Fundamental Neuroscience, University of California, San Francisco, San Francisco, CA, USA
- Weill Institute for Neuroscience, University of California, San Francisco, San Francisco, CA, USA
| | - Thomas J Davidson
- Kavli Institute for Fundamental Neuroscience, University of California, San Francisco, San Francisco, CA, USA
- Department of Physiology, University of California, San Francisco, San Francisco, CA, USA
- Howard Hughes Medical Institute, San Francisco, CA, USA
| | - Guy Bouvier
- Department of Physiology, University of California, San Francisco, San Francisco, CA, USA
- Howard Hughes Medical Institute, San Francisco, CA, USA
| | - Jesse D Marshall
- Department of Organismic & Evolutionary Biology, Harvard University, Cambridge, MA, USA
| | - Mark J Schnitzer
- Departments of Biology and Applied Physics, Stanford University, Stanford, CA, USA
- Howard Hughes Medical Institute, Stanford, CA, USA
| | - Vikaas S Sohal
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA.
- Kavli Institute for Fundamental Neuroscience, University of California, San Francisco, San Francisco, CA, USA.
- Weill Institute for Neuroscience, University of California, San Francisco, San Francisco, CA, USA.
| |
Collapse
|
8
|
Leanza L, Studerus E, Mackintosh AJ, Beck K, Seiler L, Andreou C, Riecher-Rössler A. Predictors of study drop-out and service disengagement in patients at clinical high risk for psychosis. Soc Psychiatry Psychiatr Epidemiol 2020; 55:539-548. [PMID: 31646355 DOI: 10.1007/s00127-019-01796-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 10/09/2019] [Indexed: 01/25/2023]
Abstract
PURPOSE Study drop-out during follow-up and service disengagement frequently occur in patients at clinical high risk for psychosis (CHR-P). However, little is known about their predictors. Therefore, we aimed to analyze the rate and reasons for drop-out and service disengagement in CHR-P patients and investigate their sociodemographic and clinical predictors. METHODS Data from 200 patients of the prospective Früherkennung von Psychosen (FePsy) study were analyzed with competing risks survival models, considering drop-out and transition to psychosis as competing events. To investigate whether symptoms changed immediately before drop-out, t tests were applied. RESULTS Thirty-six percent of patients dropped out within 5 years. Almost all drop-outs also disengaged from our service. Hence, study drop-out was used as a proxy for service disengagement. Patients with more severe baseline disorganized symptoms and a late inclusion into the study were significantly more likely to disengage. Immediately before disengagement, there was significant improvement in negative symptoms only. CONCLUSION A considerable proportion of CHR-P patients disengaged from our clinical study and service. Patients who were included during a later study period with more assessments disengaged more often, which might have been due to more frequent invitations to follow-up assessments and thereby increasing participation burden. Hence, our study provides a cautionary note on high-frequency follow-up assessments. Larger-scale studies evaluating predictors on multiple domains would help to further elucidate drop-out and disengagement.
Collapse
Affiliation(s)
- Letizia Leanza
- Center for Psychotic Disorders, University of Basel Psychiatric Hospital, University of Basel, Basel, Switzerland.,Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
| | - Erich Studerus
- Division of Personality and Developmental Psychology, Department of Psychology, University of Basel, Basel, Switzerland
| | - Amatya J Mackintosh
- Center for Psychotic Disorders, University of Basel Psychiatric Hospital, University of Basel, Basel, Switzerland.,Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
| | - Katharina Beck
- Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
| | - Leonie Seiler
- Center for Psychotic Disorders, University of Basel Psychiatric Hospital, University of Basel, Basel, Switzerland
| | - Christina Andreou
- Center for Psychotic Disorders, University of Basel Psychiatric Hospital, University of Basel, Basel, Switzerland
| | | |
Collapse
|
9
|
Chan CC, Bulbena-Cabre A, Rutter S, Benavides C, McClure MM, Calabrese W, Rosell DR, Koenigsberg HW, Goodman M, New AS, Hazlett EA, Perez-Rodriguez MM. Comparison of self-report and clinician-rated schizotypal traits in schizotypal personality disorder and community controls. Schizophr Res 2019; 209:263-268. [PMID: 30635257 PMCID: PMC6614007 DOI: 10.1016/j.schres.2018.12.050] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 12/27/2018] [Accepted: 12/27/2018] [Indexed: 01/06/2023]
Abstract
Given the common use of self-report questionnaires to assess schizotypy in personality pathology and schizophrenia research, it is important to determine the concordance between self-report and clinician ratings. 250 individuals with schizotypal personality disorder (SPD) and 116 community controls (CTR) were assessed on schizotypal traits using a clinical interview, the Structured Interview for DSM-IV Personality disorders (SIDP), and a self-report questionnaire, the Schizotypal Personality Questionnaire (SPQ). Ordinal logistic regressions examined concordance between self-reported and clinician-rated scores in CTR and SPD separately. Analyses of variance examined how the SPQ performed on differentiating between CTR with low schizotypy, CTR with high schizotypy, and SPD. For both CTR and SPD, higher SPQ subscale scores were significantly associated with higher clinician ratings on the respective SIDP items for the Ideas of Reference, Magical Thinking, Unusual Perceptual Experience, Suspiciousness, and Social Anxiety items, but not the Odd Speech or Limited Affect items. Higher SPQ subscale scores for Odd Behavior and Lack of Close Friends were significantly associated with the clinician-rated SIDP item scores in CTR but not SPD. CTR with low schizotypy scored lower on all SPQ subscales than CTR with high schizotypy, who did not differ from SPD. Self-report ratings are concordant with clinician ratings for positive schizotypal traits, whereas certain disorganization and interpersonal traits are not, particularly for individuals with SPD. The SPQ can differentiate between high and low schizotypy controls, but not between high schizotypy controls and individuals with SPD. Assessment of schizotypal traits should include both self-report questionnaires and clinician ratings.
Collapse
Affiliation(s)
- Chi C. Chan
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, New York, NY, USA,VISN 2 Mental Illness Research Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA,Co-corresponding authors: Chi C. Chan, PhD, Mental Illness Research, Education, and Clinical Center, James J. Peters VA Medical Center, 130 West Kingsbridge Road, Bronx, NY 10468; tel: 718-584-5000 x3862; fax: 718-364-3576; .; M. Mercedes Perez-Rodriguez, MD, PhD. Psychiatry Department, Icahn School of Medicine, Mount Sinai, 1 Gustave L Levy Pl., PO BOX 1230, New York, NY 10029.
| | - Andrea Bulbena-Cabre
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, New York, NY, USA,VISN 2 Mental Illness Research Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
| | - Sarah Rutter
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, New York, NY, USA
| | - Caridad Benavides
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, New York, NY, USA
| | - Margaret M. McClure
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, New York, NY, USA,Fairfield University, Fairfield, CT, USA
| | - William Calabrese
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, New York, NY, USA
| | - Daniel R. Rosell
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, New York, NY, USA
| | - Harold W. Koenigsberg
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, New York, NY, USA,VISN 2 Mental Illness Research Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
| | - Marianne Goodman
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, New York, NY, USA,VISN 2 Mental Illness Research Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
| | - Antonia S. New
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, New York, NY, USA
| | - Erin A. Hazlett
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, New York, NY, USA,VISN 2 Mental Illness Research Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
| | - M. Mercedes Perez-Rodriguez
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, New York, NY, USA,Co-corresponding authors: Chi C. Chan, PhD, Mental Illness Research, Education, and Clinical Center, James J. Peters VA Medical Center, 130 West Kingsbridge Road, Bronx, NY 10468; tel: 718-584-5000 x3862; fax: 718-364-3576; .; M. Mercedes Perez-Rodriguez, MD, PhD. Psychiatry Department, Icahn School of Medicine, Mount Sinai, 1 Gustave L Levy Pl., PO BOX 1230, New York, NY 10029.
| |
Collapse
|
10
|
Daneault JG, Maraj A, Lepage M, Malla A, Schmitz N, Iyer SN, Joober R, Shah JL. Medication adherence in first episode psychosis: the role of pre-onset subthreshold symptoms. Acta Psychiatr Scand 2019; 139:336-347. [PMID: 30712261 PMCID: PMC6426680 DOI: 10.1111/acps.13011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/29/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The experience of pre-onset subthreshold psychotic symptoms (STPS, signifying a clinical high-risk state) in first episode psychosis (FEP) predicts poorer outcomes during treatment, possibly through differential adherence to medication. We explored whether adherence differs between FEP patients with and without pre-onset STPS. METHODS Antipsychotic medication adherence was compared in 263 STPS+ and 158 STPS- subjects in a specialized early intervention program for FEP. Data were gathered from a larger observational study conducted between 2003 and 2016. STPS status, sociodemographic, and baseline clinical variables were tested as predictors of non-adherence using univariate and multivariate logistic regressions. Time to onset of non-adherence was analyzed using Kaplan-Meier curves. The same predictors were tested as predictors of time to onset of non-adherence using Cox regression models. RESULTS Medication non-adherence was higher in STPS+ participants (78.9% vs. 68.9%). STPS status (OR 1.709), substance use disorder (OR 1.767), and milder positive symptoms (OR 0.972) were significant baseline predictors of non-adherence. Substance use disorder (HR 1.410), milder positive symptoms (HR 0.990), and lack of contact between the clinical team and relatives (HR 1.356) were significant baseline predictors of time to non-adherence. CONCLUSION FEP patients who experience pre-onset STPS are more likely to be non-adherent to antipsychotic medication over 2 years of intervention. FEP programs should routinely evaluate pre-onset symptomatology to deliver more personalized treatments, with emphasis on engaging both patients and family members from the beginning of care.
Collapse
Affiliation(s)
- Jean-Gabriel Daneault
- Prevention and Early Intervention Program for Psychoses (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Quebec, Canada,Clinique J.-P. Mottard, Hôpital en santé mentale Albert-Prévost, Département de psychiatrie, Université de Montréal, Montreal, Quebec, Canada
| | - Anika Maraj
- Prevention and Early Intervention Program for Psychoses (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Martin Lepage
- Prevention and Early Intervention Program for Psychoses (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Quebec, Canada,Integrated Program in Neuroscience, McGill University, Montreal, Quebec, Canada,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Ashok Malla
- Prevention and Early Intervention Program for Psychoses (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Quebec, Canada,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Norbert Schmitz
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Srividya N. Iyer
- Prevention and Early Intervention Program for Psychoses (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Quebec, Canada,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Ridha Joober
- Prevention and Early Intervention Program for Psychoses (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Quebec, Canada,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Jai L. Shah
- Prevention and Early Intervention Program for Psychoses (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Quebec, Canada,Integrated Program in Neuroscience, McGill University, Montreal, Quebec, Canada,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| |
Collapse
|
11
|
Ajnakina O, David AS, Murray RM. 'At risk mental state' clinics for psychosis - an idea whose time has come - and gone! Psychol Med 2019; 49:529-534. [PMID: 30585562 DOI: 10.1017/s0033291718003859] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
At Risk Mental State (ARMS) clinics are specialised mental health services for young, help-seeking people, thought to be at ultra-high risk of developing psychosis. Their stated purpose is to reduce transitions from the ARMS state to clinical psychotic disorder. Reports of ARMS clinics provide 'evidence-based recommendations' or 'guidance' for the treatment of such individuals, and claim that such clinics prevent the development of psychosis. However, we note that in an area with a very well-developed ARMS clinic (South London), only a very small proportion (4%) of patients with first episode psychosis had previously been seen at this clinic with symptoms of the ARMS. We conclude that the task of reaching sufficient people to make a major contribution to the prevention of psychosis is beyond the power of ARMS clinics. Following the preventative approaches used for many medical disorders (e.g. lung cancer, coronary artery disease), we consider that a more effective way of preventing psychosis will be to adopt a public health approach; this should attempt to decrease exposure to environmental factors such as cannabis use which are known to increase risk of the disorder.
Collapse
Affiliation(s)
- Olesya Ajnakina
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, UK
- Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Anthony S David
- Institute of Mental Health, University College London, London, UK
| | - Robin M Murray
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, UK
- Department of Psychiatry, Experimental Biomedicine and Clinical Neuroscience (BIONEC), University of Palermo, Palermo, Italy
| |
Collapse
|
12
|
Clark SV, Mittal VA, Bernard JA, Ahmadi A, King TZ, Turner JA. Stronger default mode network connectivity is associated with poorer clinical insight in youth at ultra high-risk for psychotic disorders. Schizophr Res 2018; 193:244-250. [PMID: 28688741 PMCID: PMC5756141 DOI: 10.1016/j.schres.2017.06.043] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 06/09/2017] [Accepted: 06/22/2017] [Indexed: 12/22/2022]
Abstract
Impaired clinical insight (CI) is a common symptom of psychotic disorders and a promising treatment target. However, to date, our understanding of how variability in CI is tied to underlying brain dysfunction in the clinical high-risk period is limited. Developing a stronger conception of this link will be a vital first step for efforts to determine if CI can serve as a useful prognostic indicator. The current study investigated whether variability in CI is related to major brain networks in adolescents and young adults at ultra high-risk (UHR) of developing psychosis. Thirty-five UHR youth were administered structured clinical interviews as well as an assessment for CI and underwent resting-state magnetic resonance imaging scans. Functional connectivity was calculated in the default mode network (DMN) and fronto-parietal network (FPN), two major networks that are dysfunctional in psychosis and are hypothesized to affect insight. Greater DMN connectivity between the posterior cingulate/precuneus and ventromedial prefrontal cortex (DMN) was related to poorer CI (R2=0.399). There were no significant relationships between insight and the FPN. This is the first study to relate a major brain network to clinical insight before the onset of psychosis. Findings are consistent with evidence if a hyperconnected DMN in schizophrenia and UHR, and similar to a previous study of insight and connectivity in schizophrenia. Results suggest that a strongly connected DMN may be related to poor self-awareness of subthreshold psychotic symptoms in UHR adolescents and young adults.
Collapse
Affiliation(s)
- Sarah V Clark
- Georgia State University, Department of Psychology, Atlanta, GA, USA.
| | - Vijay A Mittal
- Northwestern University, Department of Psychology, Evanston, Chicago, IL, USA; Northwestern University, Department of Psychiatry, Evanston, Chicago, IL, USA; Northwestern University, Institute for Policy Research, Evanston, Chicago, IL, USA; Northwestern University, Department of Medical Social Sciences, Evanston, Chicago, IL, USA
| | - Jessica A Bernard
- Texas A&M University, Department of Psychology, College Station, TX, USA
| | - Aral Ahmadi
- Georgia State University, Department of Psychology, Atlanta, GA, USA
| | - Tricia Z King
- Georgia State University, Department of Psychology, Atlanta, GA, USA
| | - Jessica A Turner
- Georgia State University, Department of Psychology, Atlanta, GA, USA; The Mind Research Network, Albuquerque, NM, USA
| |
Collapse
|
13
|
The relationship between cognitive insight and cognitive performance among individuals with at-risk mental state for developing psychosis. Schizophr Res 2018; 192:281-286. [PMID: 28442249 DOI: 10.1016/j.schres.2017.04.031] [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: 01/31/2017] [Revised: 04/13/2017] [Accepted: 04/16/2017] [Indexed: 11/24/2022]
Abstract
Impairments in cognitive insight-the capacity to appraise and modify one's own distorted beliefs-are believed to be associated with the formation of psychosis. Nevertheless, the association between cognitive insight and cognitive function among people with at-risk mental state (ARMS) for developing psychotic illness has not been made clear. In this study, we used the Beck Cognitive Insight Scale (BCIS) to assess cognitive insight and the Brief Assessment of Cognition in Schizophrenia (BACS) and the Wisconsin Card Sorting Test (WCST) to assess cognitive functions. Fifty subjects with ARMS and 29 healthy volunteers were recruited as participants. The scores for the two groups on the BCIS, BACS, and WCST were compared and Spearman's rank correlations between the domains of the BCIS and cognitive performance were examined in each group. No significant differences were found in BCIS scores between these groups, whereas all of the cognitive function scores were poorer in the participants with ARMS. In the ARMS group, higher self-certainty on the BCIS was significantly correlated with lower performance in the mean number of categories achieved (ρ=-0.31, P=0.03) and perseverative errors of the Nelson type (ρ=0.29, P=0.04) on the WCST. This indicates that excessively high self-certainty might be linked with weaknesses in cognitive flexibility or set-shifting ability in people with ARMS.
Collapse
|
14
|
Spitz A, Studerus E, Koranyi S, Rapp C, Ramyead A, Ittig S, Heitz U, Uttinger M, Riecher-Rössler A. Correlations between self-rating and observer-rating of psychopathology in at-risk mental state and first-episode psychosis patients: influence of disease stage and gender. Early Interv Psychiatry 2017; 11:461-470. [PMID: 26376725 DOI: 10.1111/eip.12270] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 08/17/2015] [Indexed: 01/25/2023]
Abstract
AIM Research findings on the correlations between self-rating and observer-rating of schizophrenic psychopathology are inconsistent and have rarely considered first-episode psychosis (FEP) and at-risk mental state (ARMS) for psychosis patients. This study investigates these correlations in ARMS and FEP patients and how they are moderated by disease stage and gender. METHODS In the Basel Früherkennung von Psychosen (FePsy) study, positive and negative psychotic and affective symptoms were rated in 126 ARMS and 94 FEP patients using two observer- and three self-rating scales. The agreement between self-rating and observer-rating and the moderating influence of disease stage and gender was quantified using Pearson correlation and multiple regression models. RESULTS Correlations between self- and observer-rated subscales covering the same symptom dimension were low and mostly non-significant except for one correlation of positive and one of negative symptoms. There was no moderating influence of disease stage and gender on the correlations between self-rating and observer-rating except for one higher association in positive symptoms in FEP compared to ARMS and in women compared to men. However, these significant interaction effects did not withstand correction for multiple testing. CONCLUSIONS This study suggests that the agreement between self-rating and observer-rating in FEP and ARMS patients is rather low, similar across symptom dimensions, and only partially dependent on disease stage and gender. However, low correlations between self-rating and observer-rating do not necessarily indicate that these patients have difficulties reporting their symptoms. They could also have occurred because the scales did not exactly cover the same symptom dimensions.
Collapse
Affiliation(s)
- Andrea Spitz
- University of Basel Psychiatric Clinics, Center for Gender Research and Early Detection, Basel, Switzerland
| | - Erich Studerus
- University of Basel Psychiatric Clinics, Center for Gender Research and Early Detection, Basel, Switzerland
| | - Susan Koranyi
- University of Leipzig, Department of Medical Psychology and Medical Sociology, Leipzig, Germany
| | - Charlotte Rapp
- Psychiatric Services, Treatment Center for Psychosis, Solothurn, Switzerland
| | - Avinash Ramyead
- University of Basel Psychiatric Clinics, Center for Gender Research and Early Detection, Basel, Switzerland
| | - Sarah Ittig
- University of Basel Psychiatric Clinics, Center for Gender Research and Early Detection, Basel, Switzerland
| | - Ulrike Heitz
- University of Basel Psychiatric Clinics, Center for Gender Research and Early Detection, Basel, Switzerland
| | - Martina Uttinger
- University of Basel Psychiatric Clinics, Center for Gender Research and Early Detection, Basel, Switzerland
| | - Anita Riecher-Rössler
- University of Basel Psychiatric Clinics, Center for Gender Research and Early Detection, Basel, Switzerland
| |
Collapse
|
15
|
Abstract
BACKGROUND Schizophrenia is a chronic psychiatric disorder that generally begins in late adolescence or early adulthood. This early onset is often linked with a devastating lifelong impact on both the social network and work capacities of the affected subjects. Beginning in the mid-1990s, several sets of diagnostic criteria aiming to identify "high-risk" patients were developed and applied in clinical studies. Short-term rates of onset of psychosis in this subgroup of subjects ranged from 20% to 40%. However, 20 years later, the proposal to introduce "psychosis risk syndrome" as a coded diagnostic category in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders remained controversial and was finally rejected. Instead, "attenuated psychosis syndrome" was included in section III of the newly published manual as a condition for further studies. OBJECTIVE The goal of this article is to review the extant literature concerning the advantages and risks of early assessment of psychotic symptoms ("prodrome" and "psychosis-risk syndrome") and concerning available therapeutic options, both psychosocial and pharmacological. CONCLUSIONS "Attenuated psychosis syndrome" is a clinically useful concept. It identifies help-seeking individuals with mental health problems who need an intervention and who, if no treatment strategy is proposed, present a higher likelihood of developing a psychosis spectrum disorder in the years following their first contact with a mental health facility. In parallel with the clinical utility of this concept, additional research focused on this group of patients is warranted to further understand the emerging phase of psychotic disorders and to develop effective and efficient evidence-based prevention strategies.
Collapse
|
16
|
Davidson CA, Hoffman L, Spaulding WD. Schizotypal personality questionnaire--brief revised (updated): An update of norms, factor structure, and item content in a large non-clinical young adult sample. Psychiatry Res 2016; 238:345-355. [PMID: 27086255 PMCID: PMC4834869 DOI: 10.1016/j.psychres.2016.01.053] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 01/22/2016] [Accepted: 01/22/2016] [Indexed: 01/14/2023]
Abstract
This study updates and provides evidence for the dimensionality, reliability, and validity of a standard instrument for detection and measurement of schizotypy in non-clinical young adults. Schizotypy represents a set of traits on which both nonclinical and schizophrenia-spectrum populations vary meaningfully. These traits are linked to biological, cognitive, and social dimensions of serious mental illness (SMI), to clinical and subclinical variation in personal and social functioning, and to risk for SMI. Reliable and valid identification of schizotypal traits has important implications for clinical practice and research. Four consecutive independent samples of undergraduates were administered the SPQ-BR (N=2552). Confirmatory factor analyses suggested a minor item wording change improved reliability, and this Updated questionnaire was implemented for three-quarters of the sample (SPQ-BRU). A, single-order, nine-factor structure had acceptable psychometric properties. The best fitting second-order structure included four higher-order factors that distinguished Social Anxiety and Interpersonal factors. This differentiation was supported by differential relationships with treatment history. The Disorganized factor had the greatest unique relationship with personal and family treatment history. With few exceptions, factor loadings showed stability across samples. Overall, the higher-order and lower-order factors of schizotypy demonstrated reliability and convergent and discriminant validity; detailed psychometric data are presented in a supplement.
Collapse
Affiliation(s)
- Charlie A. Davidson
- University of Nebraska-Lincoln, Psychology Department, 238 Burnett Hall, Lincoln, NE 68588-0308, USA,Yale University School of Medicine, Department of Psychiatry, 300 George St., Suite 901, New Haven, CT 06511, USA,Correspondence to: VA Connecticut Healthcare, Building 14 950 Campbell Ave, West Haven, CT 06516, USA
| | - Lesa Hoffman
- University of Kansas, Schiefelbusch Institute for Life Span Studies, Dole Human Development Center Rm 1052, 1000 Sunnyside Avenue, Lawrence, KS 66045, USA.
| | - William D. Spaulding
- University of Nebraska-Lincoln, Psychology Department, 238 Burnett Hall, Lincoln, NE 68588-0308, USA
| |
Collapse
|
17
|
Valmaggia LR, Byrne M, Day F, Broome MR, Johns L, Howes O, Power P, Badger S, Fusar-Poli P, McGuire PK. Duration of untreated psychosis and need for admission in patients who engage with mental health services in the prodromal phase. Br J Psychiatry 2015; 207:130-134. [PMID: 26045348 PMCID: PMC4655441 DOI: 10.1192/bjp.bp.114.150623] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 12/19/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND It is unknown whether prodromal services improve outcomes in those who go on to develop psychosis, and whether these patients are demographically different from the overall first-episode population. AIMS To compare sociodemographic features, duration of untreated psychosis, hospital admission and frequency of compulsory treatment in the first year after the onset of psychosis in patients who present to prodromal services with patients who did not present to services until the first episode of psychosis. METHOD We compared two groups of patients with first-episode psychosis: one who made transition after presenting in the prodromal phase and the other who had presented with a first episode. RESULTS The patients who had presented before the first episode were more likely to be employed and less likely to belong to an ethnic minority group. They had a shorter duration of untreated psychosis, and were less likely to have been admitted to hospital and to have required compulsory treatment. CONCLUSIONS Patients who develop psychosis after being engaged in the prodromal phase have a better short-term clinical outcome than patients who do not present until the first episode. Patients who present during first episodes may be more likely to have sociodemographic features associated with relatively poor outcomes.
Collapse
Affiliation(s)
- Lucia R. Valmaggia
- King’s College London, Institute of Psychiatry, United Kingdom
,Outreach and Support in South London, South London and Maudsley NHS Foundation Trust, United Kingdom
,Corresponding author: Lucia Valmaggia, King’s College London, Institute of Psychiatry (PO 77), De Crespigny Park, SE5 8AF London, United Kingdom,
| | - Majella Byrne
- King’s College London, Institute of Psychiatry, United Kingdom
,Outreach and Support in South London, South London and Maudsley NHS Foundation Trust, United Kingdom
| | - Fern Day
- King’s College London, Institute of Psychiatry, United Kingdom
| | | | - Louise Johns
- King’s College London, Institute of Psychiatry, United Kingdom
| | - Oliver Howes
- King’s College London, Institute of Psychiatry, United Kingdom
| | - Paddy Power
- St Patrick’s Mental Health Services, Dublin, Ireland
| | - Steven Badger
- Outreach and Support in South London, South London and Maudsley NHS Foundation Trust, United Kingdom
| | - Paolo Fusar-Poli
- King’s College London, Institute of Psychiatry, United Kingdom
,Outreach and Support in South London, South London and Maudsley NHS Foundation Trust, United Kingdom
| | - Philip K McGuire
- King’s College London, Institute of Psychiatry, United Kingdom
,Outreach and Support in South London, South London and Maudsley NHS Foundation Trust, United Kingdom
| |
Collapse
|
18
|
Schmidt SJ, Grunert VM, Schimmelmann BG, Schultze-Lutter F, Michel C. Differences in coping, self-efficacy, and external control beliefs between patients at-risk for psychosis and patients with first-episode psychosis. Psychiatry Res 2014; 219:95-102. [PMID: 24878297 DOI: 10.1016/j.psychres.2014.04.045] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 01/24/2014] [Accepted: 04/28/2014] [Indexed: 10/25/2022]
Abstract
Patients with first-episode psychosis (FEP) often show dysfunctional coping patterns, low self-efficacy, and external control beliefs that are considered to be risk factors for the development of psychosis. Therefore, these factors should already be present in patients at-risk for psychosis (AR). We compared frequencies of deficits in coping strategies (Stress-Coping-Questionnaires, SVF-120/SVF-KJ), self-efficacy, and control beliefs (Competence and Control Beliefs Questionnaire, FKK) between AR (n=21) and FEP (n=22) patients using a cross-sectional design. Correlations among coping, self-efficacy, and control beliefs were assessed in both groups. The majority of AR and FEP patients demonstrated deficits in coping skills, self-efficacy, and control beliefs. However, AR patients more frequently reported a lack of positive coping strategies, low self-efficacy, and a fatalistic externalizing bias. In contrast, FEP patients were characterized by being overly self-confident. These findings suggest that dysfunctional coping, self-efficacy, and control beliefs are already evident in AR patients, though different from those in FEP patients. The pattern of deficits in AR patients closely resembles that of depressive patients, which may reflect high levels of depressiveness in AR patients. Apart from being worthwhile treatment targets, these coping and belief patterns are promising candidates for predicting outcome in AR patients, including the conversion to psychosis.
Collapse
Affiliation(s)
- Stefanie J Schmidt
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstr. 111, 3000 Bern 60, Switzerland.
| | - Vera-Maria Grunert
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstr. 111, 3000 Bern 60, Switzerland
| | - Benno G Schimmelmann
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstr. 111, 3000 Bern 60, Switzerland
| | - Frauke Schultze-Lutter
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstr. 111, 3000 Bern 60, Switzerland
| | - Chantal Michel
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstr. 111, 3000 Bern 60, Switzerland
| |
Collapse
|
19
|
Valmaggia LR, Day FL, Jones C, Bissoli S, Pugh C, Hall D, Bhattacharyya S, Howes O, Stone J, Fusar-Poli P, Byrne M, McGuire PK. Cannabis use and transition to psychosis in people at ultra-high risk. Psychol Med 2014; 44:2503-2512. [PMID: 25055169 DOI: 10.1017/s0033291714000117] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Cannabis use is associated with an increased risk of developing a psychotic disorder but the temporal relationship between cannabis use and onset of illness is unclear. The objective of this study was to assess prospectively the influence of cannabis use on transition to psychosis in people at ultra-high risk (UHR) for the disorder. METHOD Lifetime and continued cannabis use was assessed in a consecutively ascertained sample of 182 people (104 male, 78 female) at UHR for psychosis. Individuals were then followed clinically for 2 years to determine their clinical outcomes. RESULTS Lifetime cannabis use was reported by 134 individuals (73.6%). However, most of these individuals had stopped using cannabis before clinical presentation (n=98, 73.1%), usually because of adverse effects. Among lifetime users, frequent use, early-onset use and continued use after presentation were all associated with an increase in transition to psychosis. Transition to psychosis was highest among those who started using cannabis before the age of 15 years and went on to use frequently (frequent early-onset use: 25%; infrequent or late-onset use: 5%; χ(2)1=10.971, p=0.001). However, within the whole sample, cannabis users were no more likely to develop psychosis than those who had never used cannabis (cannabis use: 12.7%; no use: 18.8%; χ(2)1=1.061, p=0.303). CONCLUSIONS In people at UHR for psychosis, lifetime cannabis use was common but not related to outcome. Among cannabis users, frequent use, early-onset use and continued use after clinical presentation were associated with transition to psychosis.
Collapse
Affiliation(s)
- L R Valmaggia
- Institute of Psychiatry, King's College London,London,UK
| | - F L Day
- Institute of Psychiatry, King's College London,London,UK
| | - C Jones
- Institute of Psychiatry, King's College London,London,UK
| | - S Bissoli
- Institute of Psychiatry, King's College London,London,UK
| | - C Pugh
- Institute of Psychiatry, King's College London,London,UK
| | - D Hall
- Institute of Psychiatry, King's College London,London,UK
| | | | - O Howes
- Institute of Psychiatry, King's College London,London,UK
| | - J Stone
- Institute of Psychiatry, King's College London,London,UK
| | - P Fusar-Poli
- Institute of Psychiatry, King's College London,London,UK
| | - M Byrne
- Institute of Psychiatry, King's College London,London,UK
| | - P K McGuire
- Institute of Psychiatry, King's College London,London,UK
| |
Collapse
|
20
|
Uchida T, Matsumoto K, Ito F, Ohmuro N, Miyakoshi T, Ueno T, Matsuoka H. Relationship between cognitive insight and attenuated delusional symptoms in individuals with at-risk mental state. Psychiatry Res 2014; 217:20-4. [PMID: 24656897 DOI: 10.1016/j.psychres.2014.01.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 10/10/2013] [Accepted: 01/01/2014] [Indexed: 10/25/2022]
Abstract
Cognitive insight, defined as the ability to evaluate and correct one׳s own distorted beliefs and misinterpretations, is hypothesized to contribute to the development of psychotic symptoms. We investigated cognitive insight in individuals with at-risk mental state (ARMS), which is associated with a clinically high risk of psychosis. Sixty individuals with ARMS were compared with 200 healthy controls in terms of cognitive insight measured using the Beck Cognitive Insight Scale. We also investigated the relationship between cognitive insight and attenuated delusional symptoms. In addition, we examined differences in the cognitive insight of individuals with ARMS with or without near-threshold delusional symptoms and differences in the cognitive insight of individuals with ARMS with or without later transition to psychosis. The results showed that individuals with ARMS exhibited higher self-certainty than healthy controls, indicating impairments in cognitive insight in the former. More importantly, our results revealed that self-certainty was correlated with attenuated delusional symptoms and that individuals with ARMS who had near threshold delusional symptoms had higher self-certainty. These findings indicate that overconfidence in one׳s own beliefs or judgments might be related to the formation and maintenance of attenuated delusions in individuals with ARMS.
Collapse
Affiliation(s)
- Tomohiro Uchida
- Department of Preventive Psychiatry, Tohoku University, Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan.
| | - Kazunori Matsumoto
- Department of Preventive Psychiatry, Tohoku University, Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan
| | - Fumiaki Ito
- Department of Psychiatry, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Noriyuki Ohmuro
- Department of Psychiatry, Tohoku University Graduate School of Medicine, Sendai, Japan
| | | | - Takashi Ueno
- Division of Clinical Psychology, Tohoku University, Graduate School of Education, Sendai, Japan
| | - Hiroo Matsuoka
- Department of Psychiatry, Tohoku University Graduate School of Medicine, Sendai, Japan
| |
Collapse
|
21
|
Neuropsychological, clinical and cognitive insight predictors of outcome in a first episode psychosis study. Schizophr Res 2013; 149:70-6. [PMID: 23815972 DOI: 10.1016/j.schres.2013.06.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2012] [Revised: 05/18/2013] [Accepted: 06/02/2013] [Indexed: 11/23/2022]
Abstract
The outcome of first episode psychosis (FEP) is highly variable and difficult to predict. We studied prospectively the impact of poor insight and neuropsychological deficits on outcomes in a longitudinal cohort of 127 FEP patients. Participants were assessed on 5 domains of cognitive function and 2 domains of insight (clinical and cognitive). At 12 months, patients were assessed again for symptom severity and psychosocial function. Regression analyses revealed that cognitive insight (a measure of self-reflectiveness and self-certainty) was the best baseline predictor of overall psychopathology at 12 months whereas executive function performance at admission to the study indicated later severity of negative symptoms. Other neuropsychological and insight measures were poor predictors of psychosocial function at 1 year. The results suggest that specific neuropsychological and insight factors have separate predictive capacities indicating that they are distinct psychological processes in psychosis. Cognitive insight proved to be a useful prognostic indicator, and should be considered for future studies and as a potential focus for treatment.
Collapse
|
22
|
Kao YC, Wang TS, Lu CW, Liu YP. Assessing anomalous perceptual experiences in nonpsychiatric individuals and outpatients with psychosis in Taiwan: an investigation using the cardiff anomalous perceptions scale (CAPS). Psychiatr Q 2013; 84:137-57. [PMID: 22878835 DOI: 10.1007/s11126-012-9234-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The Cardiff anomalous perceptions scale (CAPS) has been recently designed for the assessment of anomalous perceptual experiences in the general population, and includes dimensions that measure distress, intrusiveness, and frequency. The purpose of this study was to assess the psychometric properties of a Taiwanese version of the CAPS. The English version of the CAPS was translated into Taiwanese (CAPS-T) and the latter was applied to this study. We administered the questionnaire to a consecutive sample of 192 participants with (n = 106; clinical group including schizophrenia and affective psychosis) or without psychotic disorders (n = 86; non-clinical group). In addition to the CAPS-T, the Taiwanese version of the brief psychiatric symptom rating scale (BSRS) measured the severity of the psychopathology. We also tested the psychometric properties of the CAPS-T including construct validity, internal consistency, test-retest reliability, and convergent and discriminative validity. Overall, the CAPS-T showed good construct validity, internal consistency, and stability over time and correlated significantly with the psychoticism subscale of the BSRS. As predicted, the mean differences in CAPS-T scores between participants with or without a psychotic disorder were significant. Convergent and discriminative validity were satisfactory. A score of 5 was found to the best threshold in discriminating between clinical and non-clinical samples. Our findings indicate that the Taiwanese version of the CAPS is a reliable and valid instrument to measure the multidimensionality of perceptual anomalies in general and appears to complement the clinical measures of psychosis proneness in Taiwan.
Collapse
Affiliation(s)
- Yu-Chen Kao
- Department of Psychiatry, Songshan Armed Forces General Hospital, Taipei, Taiwan, ROC.
| | | | | | | |
Collapse
|
23
|
Abstract
Background: Different theories concerning pathways to insight have been proposed which underpin the numerous assessment measures. Cognitive behavioural therapy (CBT) is one treatment approach that has been used to improve insight. Aims: The aim of this review was to promote a greater focus on developing effective CBT strategies to ameliorate insight in psychosis through the exploration of the concept of insight in psychosis and evaluation of research in the area. Method: A comprehensive search and review of published studies examining the impact of CBT on insight in psychosis was conducted. We searched the databases PubMed, Medline, PsychInfo, the Psychology and Behavioral Sciences Database, and CINAHL with limits set to 10 years, humans, and English language. We hand-searched reference lists of major studies on insight, and theoretical review papers. We filtered our results according to relevance and chose 50 papers for final consideration. Results: The multidimensionality of insight is reflected in the variety of different insight measures in clinical use. Research findings on the impact of CBT on insight are conflicting. Cognitive insight and clinical insight appear to be different concepts that are not fully captured by existing measurement scales. Conclusions: The conflicting results found in research examining the impact of CBT on insight may be partially explained by the different theories underpinning insight in psychosis communicated through psychoeducation in CBT. Furthermore, the use of more than one insight assessment measure may capture the complexity of insight more effectively. Qualitative research with service users would enrich the knowledge in this area.
Collapse
|
24
|
Relationships between psychopathological variables and insight in psychosis risk syndrome and first-episode and multiepisode schizophrenia. J Nerv Ment Dis 2013; 201:229-33. [PMID: 23407202 DOI: 10.1097/nmd.0b013e3182834315] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Insight may vary across psychosis risk syndrome (PRS), first-episode schizophrenia (FES), or multiepisode schizophrenia (MES). We aimed to compare insight domains (awareness, relabeling, and compliance) in PRS, FES, and MES groups and to correlate scores with psychopathological measures. Insight was assessed in 48 (14 PRS, 16 FES, and 18 MES) patients using the Schedule for the Assessment of Insight-Expanded Version. We conducted psychopathological assessment through the Brief Psychiatric Rating Scale (BPRS). In the whole group, the BPRS psychosis factor correlated with all insight domains. In the MES group, the more severe the anxiety/depression, the higher the insight score in the symptom relabeling domain. Insight did not differ significantly between the PRS, FES, and MES groups. Our results suggest that, across different phases of the illness, lack of insight behaves like a trait and is modulated by positive symptom severity. Anxiety and depression may be associated with increased insight in patients with chronic schizophrenia.
Collapse
|
25
|
Chung YC, Kang NI, Im YJ, Kim SW, Cho IH, Lee YM, Kwon JS. Validation of the Korean version of the Eppendorf Schizophrenia Inventory as a screening measure to detect adolescents at ultra-high risk for psychosis. Early Interv Psychiatry 2013; 7:71-9. [PMID: 22672468 DOI: 10.1111/j.1751-7893.2012.00363.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
AIM No validated self-report scale is available for use as a screening tool to detect non-help-seeking adolescents at ultra-high risk (UHR) for psychosis in a community setting. The study aims to examine the reliability and validity of the Korean version of the Eppendorf Schizophrenia Inventory (K-ESI) for assessing adolescents at UHR for psychosis in a community setting. METHODS In the first study, to confirm the reliability and discriminant validity of the K-ESI, community sample (782 adolescents, 281 young adults, 122 early and middle-aged adults) and outpatients with schizophrenia (109) were recruited. A single cross-sectional survey was performed using the K-ESI for the community sample and the K-ESI and Positive and Negative Syndrome Scale for patients. In the second study, the Korean version of Youth Self Report (K-YSR) was administered initially to 1002 students. Of the 217 students whose scores were equal to or higher than the cut-off point of the K-YSR, 120 who agreed to an in-depth evaluation were interviewed using the Comprehensive Assessment of At-Risk Mental States to confirm the predictive validity of the K-ESI. RESULTS The K-ESI showed good internal consistency and excellent test-retest reliability and discriminant validity. However, the factor structure in adolescents was substantially different from that of the original ESI. The best cut-off point for the K-ESI to identify UHR adolescents was 29, with a sensitivity of 77% and a specificity of 70%. CONCLUSION The results revealed that the K-ESI can be used as a valid and reliable instrument to identify adolescents at UHR for psychosis in a community setting.
Collapse
Affiliation(s)
- Young-Chul Chung
- Department of Psychiatry, Research Institute of Clinical Medicine of Chonbuk National University and Chonbuk National University Hospital, Seoul, Korea.
| | | | | | | | | | | | | |
Collapse
|
26
|
Fusar-Poli P, Byrne M, Badger S, Valmaggia LR, McGuire PK. Outreach and support in south London (OASIS), 2001-2011: ten years of early diagnosis and treatment for young individuals at high clinical risk for psychosis. Eur Psychiatry 2012; 28:315-26. [PMID: 23137782 DOI: 10.1016/j.eurpsy.2012.08.002] [Citation(s) in RCA: 157] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Accepted: 08/13/2012] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Prevention of psychosis has become a major objective of modern clinical psychiatry. An increasing number of new services have been established in Europe and in the world. The OASIS team has become an established model where clinical practice and research are fully integrated in the field of preventative interventions in psychosis. METHOD Comprehensive analysis of different clinical and service measures describing the 2001-2011 implementation of the OASIS team. RESULTS Over the last decade, the OASIS team has received a total of 1102 referrals, mostly young males from ethnic minorities. After the assessment, 35% were diagnosed with an At Risk Mental State (ARMS) while 32% were already psychotic. Within the ARMS, 70% met the inclusion criteria for the attenuated psychotic symptoms subgroup, 1% met the inclusion criteria for the genetic deterioration syndrome, 9% met inclusion criteria for a brief and self-limited intermittent psychotic episode and the others met inclusion criteria for more than one subgroup. Most of them had at least one comorbid diagnosis, mainly relating to anxiety and depressive domains. The majority of the OASIS clients received cognitive behavioural therapy alone or in combination with antidepressants/antipsychotics. Over the 2-year follow-up time, 44 subjects (15.2%) developed a frank psychotic episode. CONCLUSIONS The OASIS service represents one of the largest and most established prodromal services in the world. The burden of research evidence and the translational impact produced on the clinical practice support the OASIS as a model for the development of similar services.
Collapse
Affiliation(s)
- P Fusar-Poli
- Department of Psychosis Studies (P063), King's College London, Institute of Psychiatry, De Crespigny Park, SE58AF London.
| | | | | | | | | |
Collapse
|
27
|
McGuire P, Selvaraj S, Howes O. Is clinical intervention in the ultra high risk phase effective? BRAZILIAN JOURNAL OF PSYCHIATRY 2012; 33 Suppl 2:s161-74. [PMID: 22286566 DOI: 10.1590/s1516-44462011000600004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Recent research suggests that early intervention in psychosis might improve the chances of recovery and may even be able to prevent the onset of psychotic disorders. Clinical intervention in subjects at ultra high risk (UHR) of psychosis can have three different objectives. The first aim is to improve the 'prodromal' symptoms and problems that subjects usually present with. The second is to reduce the risk of the subsequent onset of frank psychosis. The third objective is to minimize the delay before the initiation of antipsychotic treatment in the subgroup of UHR subjects that go on to develop a first episode of psychosis. Both pharmacological and psychological interventions appear to be effective in reducing the severity of presenting symptoms in UHR subjects. Clinical trials of the impact of these interventions on the risk of subsequent transition to psychosis have been positive, but have involved small samples, and thus the issue of whether the effects persist in the long term remains to be determined. The monitoring of UHR subjects for the first signs of frank psychosis is an effective means of reducing the delay between the onset of the first episode and the start of antipsychotic treatment. Follow-up studies are required to test whether the reduction in this delay leads to an improved long term outcome. To date, the majority of the interventions that have been used in UHR subjects, such as case management, antipsychotic medication, and cognitive behavior therapy have previously been employed in patients with established psychosis. However, it is possible that treatments that are not normally used in patients with psychotic disorders may prove effective when applied at this stage.
Collapse
Affiliation(s)
- Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, London, UK.
| | | | | |
Collapse
|
28
|
Kang NI, Park TW, Yang JC, Oh KY, Shim SH, Chung YC. Prevalence and clinical features of Thought-Perception-Sensitivity Symptoms: results from a community survey of Korean high school students. Psychiatry Res 2012; 198:501-8. [PMID: 22475525 DOI: 10.1016/j.psychres.2012.03.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Revised: 02/27/2012] [Accepted: 03/05/2012] [Indexed: 11/26/2022]
Abstract
Epidemiologic research indicates that psychosis and depression most frequently develop during adolescence. Hence, an efficient strategy for improving youth mental health would be to focus on detection of early-stage psychosis and depression in adolescence. In this study, 1461 high school students were surveyed using self-report scales. Students who scored equal to or above the cut-off value on any of the scales and who agreed to a further examination proceeded to a second assessment, using the Kiddie Schedule for Affective Disorders and Schizophrenia and Comprehensive Assessment of At-Risk Mental States along with self-reporting scales. The estimated prevalence of adolescents at ultra-high risk (UHR) for psychosis and of depression-spectrum disorders was 1.26 and 3.69% respectively. Compared with the normal group, experiences of bullying, suicidal ideation, and suicide attempts were significantly higher in these two groups; the subjects at UHR for psychosis were found to have significantly lower academic performance and lower ratings on SCRS; and submissive behavior was more prevalent in the depression-spectrum group. Our results reveal several clinical features of adolescents at UHR for psychosis and with depression-spectrum disorder and underscore the importance of accurate assessment of and early appropriate care for these adolescents.
Collapse
Affiliation(s)
- Nam-In Kang
- Department of Psychiatry, Chonbuk National University Hospital & Research Institute of Clinical Medicine, Jeonju, Republic of Korea
| | | | | | | | | | | |
Collapse
|
29
|
Bedford NJ, Surguladze S, Giampietro V, Brammer MJ, David AS. Self-evaluation in schizophrenia: an fMRI study with implications for the understanding of insight. BMC Psychiatry 2012; 12:106. [PMID: 22876974 PMCID: PMC3527271 DOI: 10.1186/1471-244x-12-106] [Citation(s) in RCA: 60] [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: 03/06/2012] [Accepted: 07/30/2012] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Lack of insight is a core feature of schizophrenia and is associated with structural brain abnormalities. The functional neuroanatomy of insight has only recently been investigated. When people evaluate their personality traits compared to those of another, activation is seen in central midline structures (CMS) of the brain. This study set out to compare cerebral activation in schizophrenia patients versus controls during a self-evaluation task which included positive and negative traits as well as mental and physical illness terms. METHODS Eleven schizophrenia patients and 8 healthy controls, matched for age were studied. Insight was assessed using the Schedule for the Assessment of Insight-expanded version (SAI-E). FMRI data were obtained with a 1.5 Tesla GE system and interactions between participant group, self versus other, significant at the cluster level, were recorded. RESULTS Significant hypoactivation in the medial superior frontal gyrus (dorsomedial prefrontal cortex) was observed in patients vs. controls during self-evaluation of all traits combined. A second cluster of hypoactivation in the posterior cingulate was also detected. When the response to individual traits was explored, underactivation in other frontal regions plus right inferior parietal lobule emerged and this tended to correlate, albeit weakly with lower insight scores. Further, there were areas of hyperactivation relative to controls in anterior cingulate, frontal and parietal regions (especially precuneus) which showed moderate inverse correlations with insight scores. CONCLUSIONS We have demonstrated that the CMS, identified as a key system underpinning self-evaluation, is dysfunctional in patients with schizophrenia, particularly dorso-medial PFC. This may have implications for lack of insight in schizophrenia. Hypofunction within the dorsomedial prefrontal region seems to be particularly important although other posterior and lateral cortical regions play a part and may modulate self-evaluative responses depending on the type of trait under consideration.
Collapse
Affiliation(s)
- Nicholas J Bedford
- Department of Psychosis Studies, Institute of Psychiatry, King’s College London, London, UK
| | - Simon Surguladze
- Department of Psychosis Studies, Institute of Psychiatry, King’s College London, London, UK
| | - Vincent Giampietro
- Department of Neuroimaging, Institute of Psychiatry, King’s College London, London, UK
| | - Michael J Brammer
- Department of Neuroimaging, Institute of Psychiatry, King’s College London, London, UK
| | - Anthony S David
- Department of Psychosis Studies, Institute of Psychiatry, King’s College London, London, UK
| |
Collapse
|
30
|
Davidsen KA, Rosenbaum B. Fear of annihilation in subjects at risk of psychosis: A pilot study. PSYCHOSIS-PSYCHOLOGICAL SOCIAL AND INTEGRATIVE APPROACHES 2012. [DOI: 10.1080/17522439.2011.588339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
31
|
Kao YC, Liu YP, Cheng TH, Lu CW. WITHDRAWN: The psychometric properties of the Taiwanese version of the Cardiff Anomalous Perceptions Scale. Compr Psychiatry 2011:S0010-440X(11)00129-5. [PMID: 21762886 DOI: 10.1016/j.comppsych.2011.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2011] [Revised: 05/07/2011] [Accepted: 05/19/2011] [Indexed: 11/21/2022] Open
Abstract
This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.
Collapse
Affiliation(s)
- Yu-Chen Kao
- Department of Psychiatry, Songshan Armed Forces General Hospital, Taipei 10581, Taiwan, Republic of China
| | | | | | | |
Collapse
|
32
|
Parellada M, Boada L, Fraguas D, Reig S, Castro-Fornieles J, Moreno D, Gonzalez-Pinto A, Otero S, Rapado-Castro M, Graell M, Baeza I, Arango C. Trait and state attributes of insight in first episodes of early-onset schizophrenia and other psychoses: a 2-year longitudinal study. Schizophr Bull 2011; 37:38-51. [PMID: 20884756 PMCID: PMC3004178 DOI: 10.1093/schbul/sbq109] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Increasing evidence supports the important role of illness state and individual characteristics in insight. METHODS Insight, as measured with the Scale to Assess Unawareness of Mental Disorder, over the first 2 years of early-onset first-episode psychosis and its correlations with clinical, socio-demographic, cognitive, and structural brain variables are studied. RESULTS (1) insight at 2 years is poorer in schizophrenia spectrum disorders (SSDs) than in subjects with other psychoses; (2) the more severe the psychosis, the worse the insight. In SSD, depressive symptoms, poorer baseline executive functioning, lower IQ, longer duration of untreated psychosis (DUP), and poorer premorbid infancy adjustment are associated with poorer insight; frontal and parietal gray matter (GM) reductions at baseline correlate with worse insight into having psychotic symptoms at 2 years; (3) insight into having a mental disorder (Scale to Assess Unawareness of Mental Disorder [SUMD]1) at 1 year, DUP, and baseline IQ are the most consistent variables explaining different aspects of insight at 2 years in SSD patients. IQ and SUMD1 at 1 year, together with left frontal and parietal GM volumes, explain 80% of the variance of insight into having specific psychotic symptoms in SSD patients (adjusted R(2) = 0.795, F = 15.576, P < .001). CONCLUSION Insight is a complex phenomenon that depends both on severity of psychopathology and also on disease and subject characteristics, such as past adjustment, IQ, DUP, cognitive functioning, frontal and parietal GM volumes, and age, gender, and ethnicity.
Collapse
Affiliation(s)
- Mara Parellada
- Department of Psychiatry, Hospital General Universitario Gregorio Marañón, Ibiza 43, Madrid 28009, Spain.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Müller M, Vetter S, Buchli-Kammermann J, Stieglitz RD, Stettbacher A, Riecher-Rössler A. The Self-screen-Prodrome as a short screening tool for pre-psychotic states. Schizophr Res 2010; 123:217-24. [PMID: 20840886 DOI: 10.1016/j.schres.2010.08.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2009] [Revised: 07/19/2010] [Accepted: 08/09/2010] [Indexed: 11/25/2022]
Abstract
BACKGROUND Early detection of psychosis is an important issue in current research. Early intervention helps to improve the outcome of the disorder. Therefore, a comprehensive examination in large populations, necessary as it might be, is economically almost not feasible. A screening via self-report is more practicable as it helps focus on individuals with high symptom loads. AIM To examine aspects of validity of the Self-screen-Prodrome (SPro) as a new screening tool for prodromal states of psychosis in a military sample. METHOD 938 Swiss conscripts were assessed with the SPro, the Eppendorf Schizophrenia-Inventory (ESI) and the Symptom-Checklist-90-Revised (SCL-90-R). Conscripts with potential psychosis-like pathology (T-transformed Severity Index of the SCL-90-R-subscales Psychoticism [PSYC] and Paranoid Ideation [PARA]≥63) were compared with those not meeting the criteria of this condition (non-cases). RESULTS Both groups (cases and non-cases) showed significant differences in their mean scores on SPro and ESI, although only the SPro had satisfactory effect sizes. In hierarchic logistic regression models the SPro turned out to be highly predictive for caseness while ESI-scales were not significant. A cut-off score of ≥2 on the SPro subscale for psychotic risk (SPro-Psy-Risk) was found to identify caseness best with a sensitivity of 74% and a specificity of 61%. CONCLUSION The SPro has proven to be a valid and very economic screening tool for general and prodromal pathology in large populations.
Collapse
Affiliation(s)
- Mario Müller
- Centre for Disaster and Military Psychiatry, University of Zurich, Militärstrasse 8, 8021 Zurich, Switzerland
| | | | | | | | | | | |
Collapse
|
34
|
Johns LC, Allen P, Valli I, Winton-Brown T, Broome M, Woolley J, Tabraham P, Day F, Howes O, Wykes T, McGuire P. Impaired verbal self-monitoring in individuals at high risk of psychosis. Psychol Med 2010; 40:1433-1442. [PMID: 19951449 DOI: 10.1017/s0033291709991991] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Cognitive models suggest that auditory verbal hallucinations arise through defective self-monitoring and the external attribution of inner speech. We used a paradigm that engages verbal self-monitoring (VSM) to examine whether this process is impaired in people experiencing prodromal symptoms, who have a very high risk of developing psychosis. METHOD We tested 31 individuals with an At-Risk Mental State (ARMS) and 31 healthy volunteers. Participants read single adjectives aloud while the source and pitch of the online auditory verbal feedback was manipulated, then immediately identified the source of the speech they heard (Self/Other/Unsure). Response choice and reaction time were recorded. RESULTS When reading aloud with distorted feedback of their own voice, ARMS participants made more errors than controls (misidentifications and unsure responses). ARMS participants misidentified the source of their speech as 'Other' when the level of acoustic distortion was severe, and misidentification errors were inversely related to reaction times. CONCLUSIONS Impaired VSM is evident in people with an ARMS, although the deficit seems to be less marked than in patients with schizophrenia. Follow-up of these participants may clarify the extent to which the severity of this impairment predicts the subsequent onset of psychosis and development of positive symptoms.
Collapse
Affiliation(s)
- L C Johns
- Department of Psychological Medicine, Institute of Psychiatry, King's College London, UK.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Rodriguez CI, Corcoran C, Simpson HB. Diagnosis and treatment of a patient with both psychotic and obsessive-compulsive symptoms. Am J Psychiatry 2010; 167:754-61. [PMID: 20595428 PMCID: PMC3859191 DOI: 10.1176/appi.ajp.2009.09070997] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
When a patient presents with both psychotic and obsessive-compulsive symptoms, the clinician is faced with a differential diagnosis that includes comorbid schizophrenia and obsessive-compulsive disorder (OCD), OCD with poor insight, and schizophrenia with antipsychotic-induced obsessive-compulsive symptoms. If the psychotic symptoms are subthresh-old or attenuated in form, the individual may have OCD and putative prodromal schizophrenia. The authors present a case to outline a strategy for differentiating among these possible diagnoses and for optimizing treatment.
Collapse
Affiliation(s)
- Carolyn I Rodriguez
- New York State Psychiatric Institute, 1051 Riverside Dr., Unit 69, New York, NY 10032, USA.
| | | | | |
Collapse
|
36
|
|
37
|
Effects of aripiprazole on insight and subjective experience in individuals with an at-risk mental state. J Clin Psychopharmacol 2009; 29:421-5. [PMID: 19745640 DOI: 10.1097/jcp.0b013e3181b2fe22] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Although medication with antipsychotic for the psychosis prodrome has often caused some ethical issues, recent studies have shown that some novel antipsychotics are safer and more tolerable for young people. This study aimed to investigate whether the administration of aripiprazole would not only relieve the prodromal symptoms but also be tolerable for prodromal subjects and to evaluate the effect of medication on improvements in insight and subjective well-being. METHODS The Structured Interview for Prodromal Syndromes was performed for patients identified as having the psychosis prodrome. Psychiatric measures included the Scale of Prodromal Symptoms. Clinical insight was measured using the Scale to Assess Unawareness of Mental Disorder, and changes in subjective experience were assessed using the Subjective Well-being Under Neuroleptics, Short version. The time frame was the first 8 weeks after beginning study medication. RESULTS Thirty-six treatment-seeking prodromal patients (men, 42%; mean [SD] age, 23.4 [5.6] years) were enrolled. At the 12-week follow-up point, 30 participants (83%) remained in the trial. Improvements on the Scale of Prodromal Symptoms and Scale to Assess Unawareness of Mental Disorder scores were statistically significant at end point. Although the Subjective Well-being Under Neuroleptics, Short version total scores improved significantly at 4 weeks, however, they did not change significantly from baseline at 8 weeks. CONCLUSIONS This trial suggests that aripiprazole not only produces a clinical benefit in prodromal subjects but also results in a high adherence to medication with immediate improvements in insight and subjective well-being. Although further placebo-controlled studies are needed, aripiprazole might be a first-line treatment for individuals at imminent risk for psychosis.
Collapse
|
38
|
Abstract
Insight is a reliably measured construct that is stable across cultures, with several aspects assessed frequently. Insight impairment in schizophrenia appears to be more stable than in mania and tends to be worse at all stages than other psychoses or "at-risk states." Good insight may lead to temporary low mood and poor self-image, but these processes are complex and perhaps not the same at different stages of illness. Depression and hopelessness mediate insight's relationship with suicidality. Insight predicts low self-rating of quality of life but better observer rating and social function. It did not predict violence in one large study but did in shorter-term studies of forensic or first-admission populations. First-episode studies find consistent links with relapse and readmission but weak evidence of insight predicting symptoms or function at follow-up. Atypical antipsychotics were not specifically beneficial in one large trial, but cognitive-behavioral therapy was in another.
Collapse
|