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Clauss JA, Foo CYS, Leonard CJ, Dokholyan KN, Cather C, Holt DJ. Screening for psychotic experiences and psychotic disorders in general psychiatric settings: a systematic review and meta-analysis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.04.14.24305796. [PMID: 38699350 PMCID: PMC11065042 DOI: 10.1101/2024.04.14.24305796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
Background The absence of systematic screening for psychosis within general psychiatric services contribute to substantial treatment delays and poor long-term outcomes. We conducted a meta-analysis to estimate rates of psychotic experiences, clinical high-risk for psychosis syndrome (CHR-P), and psychotic disorders identified by screening treatment-seeking individuals to inform implementation recommendations for routine psychosis screening in general psychiatric settings. Methods PubMed and Web of Science databases were searched to identify empirical studies that contained information on the point prevalence of psychotic experiences, CHR-P, or psychotic disorders identified by screening inpatient and outpatient samples aged 12-64 receiving general psychiatric care. Psychotic experiences were identified by meeting threshold scores on validated self-reported questionnaires, and psychotic disorders and CHR-P by gold-standard structured interview assessments. A meta-analysis of each outcome was conducted using the Restricted Maximum Likelihood Estimator method of estimating effect sizes in a random effects model. Results 41 independent samples (k=36 outpatient) involving n=25,751 patients (58% female, mean age: 24.1 years) were included. Among a general psychiatric population, prevalence of psychotic experiences was 44.3% (95% CI: 35.8-52.8%; 28 samples, n=21,957); CHR-P was 26.4% (95% CI: 20.0-32.7%; 28 samples, n=14,395); and psychotic disorders was 6.6% (95% CI: 3.3-9.8%; 32 samples, n=20,371). Conclusions High rates of psychotic spectrum illness in general psychiatric settings underscore need for secondary prevention with psychosis screening. These base rates can be used to plan training and resources required to conduct assessments for early detection, as well as build capacity in interventions for CHR-P and early psychosis in non-specialty mental health settings.
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Affiliation(s)
- Jacqueline A. Clauss
- Psychosis Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Cheryl Y. S. Foo
- Psychosis Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Katherine N. Dokholyan
- Psychosis Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Corinne Cather
- Psychosis Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Daphne J. Holt
- Psychosis Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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Spiteri-Staines AE, Yung AR, Lin A, Hartmann JA, Amminger P, McGorry PD, Thompson A, Wood SJ, Nelson B. Non-psychotic Outcomes in Young People at Ultra-High Risk of Developing a Psychotic Disorder: A Long-Term Follow-up Study. Schizophr Bull 2024:sbae005. [PMID: 38366898 DOI: 10.1093/schbul/sbae005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
BACKGROUND The majority of individuals at ultra-high risk (UHR) for psychosis do not transition to a full threshold psychotic disorder. It is therefore important to understand their longer-term clinical and functional outcomes, particularly given the high prevalence of comorbid mental disorders in this population at baseline. AIMS This study investigated the prevalence of non-psychotic disorders in the UHR population at entry and long-term follow-up and their association with functional outcomes. Persistence of UHR status was also investigated. STUDY DESIGN The sample comprised 102 UHR young people from the Personal Assessment and Crisis Evaluation (PACE) Clinic who had not transitioned to psychosis by long-term follow-up (mean = 8.8 years, range = 6.8-12.1 years since baseline). RESULTS Eighty-eight percent of participants at baseline were diagnosed with at least one mental disorder, the majority of which were mood disorders (78%), anxiety disorders (35%), and substance use disorders (SUDs) (18%). This pattern of disorder prevalence continued at follow-up, though prevalence was reduced, with 52% not meeting criteria for current non-psychotic mental disorder. However, 35% of participants developed a new non-psychotic mental disorder by follow-up. Presence of a continuous non-psychotic mental disorder was associated with poorer functional outcomes at follow-up. 28% of participants still met UHR criteria at follow-up. CONCLUSIONS The study adds to the evidence base that a substantial proportion of UHR individuals who do not transition to psychosis experience persistent attenuated psychotic symptoms and persistent and incident non-psychotic disorders over the long term. Long-term treatment and re-entry into services is indicated.
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Affiliation(s)
- Anneliese E Spiteri-Staines
- Orygen, 35 Poplar Road, Parkville 3052, Victoria, Australia
- The Centre for Youth Mental Health, University of Melbourne, Parkville 3052, Australia
- Department of Social Work, Melbourne School of Health Sciences, University of Melbourne, 161 Barry St, Carlton 3053, Australia
| | - Alison R Yung
- Orygen, 35 Poplar Road, Parkville 3052, Victoria, Australia
- The Centre for Youth Mental Health, University of Melbourne, Parkville 3052, Australia
- Institute of Mental and Physical Health and Clinical Translation (IMPACT), Deakin University, Geelong, VIC 3320, Australia
| | - Ashleigh Lin
- School of Population and Global Health, University of Western Australia, Nedlands, WA 6009, Australia
| | - Jessica A Hartmann
- Orygen, 35 Poplar Road, Parkville 3052, Victoria, Australia
- The Centre for Youth Mental Health, University of Melbourne, Parkville 3052, Australia
| | - Paul Amminger
- Orygen, 35 Poplar Road, Parkville 3052, Victoria, Australia
- The Centre for Youth Mental Health, University of Melbourne, Parkville 3052, Australia
| | - Patrick D McGorry
- Orygen, 35 Poplar Road, Parkville 3052, Victoria, Australia
- The Centre for Youth Mental Health, University of Melbourne, Parkville 3052, Australia
| | - Andrew Thompson
- Orygen, 35 Poplar Road, Parkville 3052, Victoria, Australia
- The Centre for Youth Mental Health, University of Melbourne, Parkville 3052, Australia
- Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, UK
| | - Stephen J Wood
- Orygen, 35 Poplar Road, Parkville 3052, Victoria, Australia
- The Centre for Youth Mental Health, University of Melbourne, Parkville 3052, Australia
- School of Psychology, University of Birmingham, Edgbaston, UK
| | - Barnaby Nelson
- Orygen, 35 Poplar Road, Parkville 3052, Victoria, Australia
- The Centre for Youth Mental Health, University of Melbourne, Parkville 3052, Australia
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Rossi C, De Salve F, Biagianti B, Cavalera C, Malvini L, Barbera S, Pastelli I, Tagliabue S, Oasi O, Percudani M. At-risk mental states and personality traits: A cluster analysis approach on a group of help-seeking young adults. Early Interv Psychiatry 2023; 17:1070-1078. [PMID: 36646671 DOI: 10.1111/eip.13397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 11/18/2022] [Accepted: 01/01/2023] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Research on the relationship between personality and psychosis onset is growing, with the goal of preventing or intervening early in patients' vulnerability. The identification of individuals with at-risk mental states has enabled the development of early intervention strategies, such as Programma 2000, a youth mental health service that was implemented in Milan (Italy). AIMS Focusing on the 18-25 age range-the time window with the highest incidence of psychotic onset-this study aims to identify the personality traits that may characterize the at-risk mental states and the social functioning of a group of help-seeking young adults. METHODS The sample includes 169 people (48.5% males and 51.5% females). Data were collected during an initial assessment that comprised the Social and Occupational Functioning Assessment Scale, the Personality Inventory for DSM-5, the Checklist ERIraos and a clinical session. RESULTS Results identified a three-cluster solution based on the Checklist scores: Cluster 1 'Not at psychotic risk'; Cluster 2 'At intermediate risk'; Cluster 3 'With psychotic onset'. The multivariate analysis of the variance of personality traits shows significant differences among the clusters in negative affect, detachment and disinhibition. Higher scores in these traits may distinguish individuals, not at psychotic risk from those at intermediate risk or with psychotic onset. Moreover, social functioning was found to be negatively associated with clusters of psychotic risk. CONCLUSION Findings from this study highlighted the need to evaluate personalized interventions targeting such personality traits that could prevent psychotic transition and promote psychological well-being.
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Affiliation(s)
- Chiara Rossi
- Department of Psychology, Catholic University of Milan, Milan, Italy
| | | | - Bruno Biagianti
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Cesare Cavalera
- Department of Psychology, Catholic University of Milan, Milan, Italy
| | - Lara Malvini
- Department of Mental Health and Addiction Services, Niguarda Hospital, Milan, Italy
| | - Simona Barbera
- Department of Mental Health and Addiction Services, Niguarda Hospital, Milan, Italy
| | - Ilaria Pastelli
- Department of Psychology, Catholic University of Milan, Milan, Italy
| | - Sofia Tagliabue
- Department of Mental Health and Addiction Services, Niguarda Hospital, Milan, Italy
| | - Osmano Oasi
- Department of Psychology, Catholic University of Milan, Milan, Italy
| | - Mauro Percudani
- Department of Mental Health and Addiction Services, Niguarda Hospital, Milan, Italy
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Adrien V, Liewig J, Diot T, Ferreri F, Mouchabac S, Dubertret C, Bourgin J. Association between family functioning and psychotic transition in ultra-high risk adolescents and young adults. Front Psychiatry 2023; 14:1177311. [PMID: 37415693 PMCID: PMC10320389 DOI: 10.3389/fpsyt.2023.1177311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/24/2023] [Indexed: 07/08/2023] Open
Abstract
Background Psychotic transition (PT) is a crucial stage in schizophrenia. The Comprehensive Assessment of At-Risk Mental States (CAARMS) scale can be used to identify individuals at ultra-high risk (UHR) for psychosis and to evaluate their risk of PT. Many environmental and genetic factors have been identified as contributing to the development and decompensation of schizophrenia. This study aimed to determine if the quality of family functioning is associated with PT risk in UHR individuals aged between 11 and 25 years after 1 year of follow-up. Methods From January to November 2017, 45 patients aged 12 to 25 consulting for psychiatric reasons were included. Twenty-six were classified as UHR of PT at the CAARMS. Family functioning was assessed by the Family Assessment Device-Global Functioning (FAD-GF). Thirty-seven of these patients (30% men, mean age 16 ± 2.5) were reassessed at 8-14 months of recruitment. Survival analysis was used to examine the impact of family functioning on PT risk. Results A total of 40% of UHR patients were classified as psychotic at reassessment. Survival analysis showed that better family functioning is a significant protective factor for PT in this population. Discussion This result suggests that the global family functioning has an impact at 1 year on the risk of PT in the population of adolescents and young adults who consult the hospital for psychiatric reasons. A family intervention may be effective in reducing PT risk in this population and should be considered as a potential therapeutic option.
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Affiliation(s)
- Vladimir Adrien
- AP-HP, Department of Psychiatry, Saint-Antoine Hospital, Sorbonne Université, Paris, France
- Infrastructure for Clinical Research in Neuroscience (iCRIN), Paris Brain Institute, Sorbonne Université, INSERM, CNRS, Paris, France
| | - Justine Liewig
- Department of Child and Adolescent Psychiatry, Nord-Essonne Hospital, Bures-sur-Yvette, France
| | - Thomas Diot
- AP-HP, Department of Psychiatry, Saint-Antoine Hospital, Sorbonne Université, Paris, France
| | - Florian Ferreri
- AP-HP, Department of Psychiatry, Saint-Antoine Hospital, Sorbonne Université, Paris, France
- Infrastructure for Clinical Research in Neuroscience (iCRIN), Paris Brain Institute, Sorbonne Université, INSERM, CNRS, Paris, France
| | - Stephane Mouchabac
- AP-HP, Department of Psychiatry, Saint-Antoine Hospital, Sorbonne Université, Paris, France
- Infrastructure for Clinical Research in Neuroscience (iCRIN), Paris Brain Institute, Sorbonne Université, INSERM, CNRS, Paris, France
| | - Caroline Dubertret
- AP-HP, Department of Psychiatry, Louis Mourier Hospital, Université Paris Cité, Faculté de Médecine, Colombes, France
| | - Julie Bourgin
- Department of Child and Adolescent Psychiatry, Nord-Essonne Hospital, Bures-sur-Yvette, France
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De Salve F, Rossi C, Cavalera C, Lara M, Simona B, Sofia T, Mauro P, Osmano O. Personality traits and transition to psychosis one year after the first assessment. Front Psychol 2023; 14:1096626. [PMID: 36743236 PMCID: PMC9893640 DOI: 10.3389/fpsyg.2023.1096626] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 01/02/2023] [Indexed: 01/21/2023] Open
Abstract
Introduction Several studies have identified ultra-high-risk criteria that may characterize an at-risk mental state and predict the transition of psychotic evolution. Personality traits may play a crucial role in this process. Aims The current study aims to: (a) explore the evolution of an initial diagnosis over 12 months; (b) assess differences in social and occupational functioning; (c) identify common (trans-diagnostic) personality traits of psychotic risk. Methods The sample includes 97 (44 males and 53 females) young adults. They completed an assessment that consists of socio-demographic data, the Social and Occupational Functioning Scale, the Early Recognition Inventory-retrospective assessment onset of schizophrenia, and the Personality Inventory for DSM-5 (PID-5). According to the tests' assessment, the sample was divided into three different groups: Ultra-High Risk (UHR), At-Risk, and Not at risk. One year after the first evaluation, psychiatrists administered the QuickSCID-5 to verify the diagnostic trajectories of the sample. Results Overall, the most prevalent category diagnoses were anxiety/depression, personality disorders, and psychosis. Specifically, the most common diagnosis in the UHR group was psychosis. Moreover, in the UHR group, the social and occupational functioning score was the lowest. In terms of differences in PID-5 personality traits, the At-risk and UHR groups scored highest in detachment and disinhibition. No statistically significant differences were found between the groups for negative affectivity, antagonism, and psychoticism traits. Conclusion Results obtained by the current study should be considered an attempt to better understand the diagnostic trajectories and trans-diagnostic personality traits in a group of young help-seekers, specifically in UHR. Findings highlight both the importance of diagnosis and personality traits evaluation to customize a specific intervention based on the level of psychotic risk. Clinical suggestions are reported.
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Affiliation(s)
- Francesca De Salve
- Department of Psychology, Catholic University of Milan, Milan, Italy,*Correspondence: Francesca De Salve, ✉
| | - Chiara Rossi
- Department of Psychology, Catholic University of Milan, Milan, Italy
| | - Cesare Cavalera
- Department of Psychology, Catholic University of Milan, Milan, Italy
| | - Malvini Lara
- Department of Mental Health and Addiction Services, Niguarda Hospital, Milan, Italy
| | - Barbera Simona
- Department of Mental Health and Addiction Services, Niguarda Hospital, Milan, Italy
| | - Tagliabue Sofia
- Department of Mental Health and Addiction Services, Niguarda Hospital, Milan, Italy
| | - Percudani Mauro
- Department of Mental Health and Addiction Services, Niguarda Hospital, Milan, Italy
| | - Oasi Osmano
- Department of Psychology, Catholic University of Milan, Milan, Italy,Oasi Osmano, ✉
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Hartmann JA, Nelson B, Amminger GP, Spark J, Yuen HP, Kerr MJ, Polari A, Wallis N, Blasioli J, Dixon L, Carter C, Loewy R, Niendam TA, Shumway M, McGorry PD. Baseline data of a sequential multiple assignment randomized trial (STEP study). Early Interv Psychiatry 2022; 16:1130-1142. [PMID: 35098659 PMCID: PMC9795376 DOI: 10.1111/eip.13263] [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: 08/11/2021] [Revised: 11/30/2021] [Accepted: 01/03/2022] [Indexed: 12/30/2022]
Abstract
AIM Research has shown that preventative intervention in individuals at ultra-high risk of psychosis (UHR) improves symptomatic and functional outcomes. The staged treatment in early psychosis (STEP) trial aims to determine the most effective type, timing and sequence of interventions in the UHR population by sequentially studying the effectiveness of (1) support and problem solving, (2) cognitive-behavioural case management and (3) antidepressant medication with an embedded fast-fail option of (4) omega-3 fatty acids or low-dose antipsychotic medication. This paper presents the recruitment flow and baseline clinical characteristics of the sample. METHODS STEP is a sequential multiple assignment randomized trial. We present the baseline demographics, clinical characteristics and acceptability and feasibility of this treatment approach as indicated by the flow of participants from first contact up until enrolment into the trial. Recruitment took place between April 2016 and January 2019. RESULTS Of 1343, help-seeking young people who were considered for participation, 402 participants were not eligible and 599 declined/disengaged, resulting in a total of 342 participants enrolled in the study. The most common reason for exclusion was an active prescription of antidepressant medication. Eighty-five percent of the enrolled sample had a non-psychotic DSM-5 diagnosis and symptomatic/functional measures showed a moderate level of clinical severity and functional impairment. DISCUSSION The present study demonstrates the acceptability and participant's general positive appraisal of sequential treatment. It also shows, in line with other trials in UHR individuals, a significant level of psychiatric morbidity and impairment, demonstrating the clear need for care in this group and that treatment is appropriate.
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Affiliation(s)
- Jessica A Hartmann
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne
| | - Barnaby Nelson
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne
| | - G. Paul Amminger
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne
| | - Jessica Spark
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne
| | - Hok Pan Yuen
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne
| | - Melissa J. Kerr
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne
| | - Andrea Polari
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne
| | - Nicky Wallis
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne
| | - Julie Blasioli
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne
| | - Lisa Dixon
- Department of Psychiatry, Columbia University, New York, New York
| | - Cameron Carter
- Department of Psychiatry and Behavioral Sciences, University of California Davis, Davis, California
| | - Rachel Loewy
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, California
| | - Tara A. Niendam
- Department of Psychiatry and Behavioral Sciences, University of California Davis, Davis, California
| | - Martha Shumway
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, California
| | - Patrick D. McGorry
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne
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Salazar de Pablo G, Radua J, Pereira J, Bonoldi I, Arienti V, Besana F, Soardo L, Cabras A, Fortea L, Catalan A, Vaquerizo-Serrano J, Coronelli F, Kaur S, Da Silva J, Shin JI, Solmi M, Brondino N, Politi P, McGuire P, Fusar-Poli P. Probability of Transition to Psychosis in Individuals at Clinical High Risk: An Updated Meta-analysis. JAMA Psychiatry 2021; 78:970-978. [PMID: 34259821 PMCID: PMC8281006 DOI: 10.1001/jamapsychiatry.2021.0830] [Citation(s) in RCA: 130] [Impact Index Per Article: 43.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
IMPORTANCE Estimating the current likelihood of transitioning from a clinical high risk for psychosis (CHR-P) to psychosis holds paramount importance for preventive care and applied research. OBJECTIVE To quantitatively examine the consistency and magnitude of transition risk to psychosis in individuals at CHR-P. DATA SOURCES PubMed and Web of Science databases until November 1, 2020. Manual search of references from previous articles. STUDY SELECTION Longitudinal studies reporting transition risks in individuals at CHR-P. DATA EXTRACTION AND SYNTHESIS Meta-analysis compliant with Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guidelines; independent data extraction, manually and through digitalization of Kaplan-Meier curves. MAIN OUTCOME AND MEASURES Primary effect size was cumulative risk of transition to psychosis at 0.5, 1, 1.5, 2, 2.5, 3, 4, and more than 4 years' follow-up, estimated using the numbers of individuals at CHR-P transitioning to psychosis at each time point. These analyses were complemented by meta-analytical Kaplan-Meier curves and speed of transition to psychosis (hazard rate). Random-effects meta-analysis, between-study heterogeneity analysis, study quality assessment, and meta-regressions were conducted. RESULTS A total of 130 studies and 9222 individuals at CHR-P were included. The mean (SD) age was 20.3 (4.4) years, and 5100 individuals (55.3%) were male. The cumulative transition risk was 0.09 (95% CI, 0.07-0.10; k = 37; n = 6485) at 0.5 years, 0.15 (95% CI, 0.13-0.16; k = 53; n = 7907) at 1 year, 0.20 (95% CI, 0.17-0.22; k = 30; n = 5488) at 1.5 years, 0.19 (95% CI, 0.17-0.22; k = 44; n = 7351) at 2 years, 0.25 (95% CI, 0.21-0.29; k = 19; n = 3114) at 2.5 years, 0.25 (95% CI, 0.22-0.29; k = 29; n = 4029) at 3 years, 0.27 (95% CI, 0.23-0.30; k = 16; n = 2926) at 4 years, and 0.28 (95% CI, 0.20-0.37; k = 14; n = 2301) at more than 4 years. The cumulative Kaplan-Meier transition risk was 0.08 (95% CI, 0.08-0.09; n = 4860) at 0.5 years, 0.14 (95% CI, 0.13-0.15; n = 3408) at 1 year, 0.17 (95% CI, 0.16-0.19; n = 2892) at 1.5 years, 0.20 (95% CI, 0.19-0.21; n = 2357) at 2 years, 0.25 (95% CI, 0.23-0.26; n = 1444) at 2.5 years, 0.27 (95% CI, 0.25-0.28; n = 1029) at 3 years, 0.28 (95% CI, 0.26-0.29; n = 808) at 3.5 years, 0.29 (95% CI, 0.27-0.30; n = 737) at 4 years, and 0.35 (95% CI, 0.32-0.38; n = 114) at 10 years. The hazard rate only plateaued at 4 years' follow-up. Meta-regressions showed that a lower proportion of female individuals (β = -0.02; 95% CI, -0.04 to -0.01) and a higher proportion of brief limited intermittent psychotic symptoms (β = 0.02; 95% CI, 0.01-0.03) were associated with an increase in transition risk. Heterogeneity across the studies was high (I2 range, 77.91% to 95.73%). CONCLUSIONS AND RELEVANCE In this meta-analysis, 25% of individuals at CHR-P developed psychosis within 3 years. Transition risk continued increasing in the long term. Extended clinical monitoring and preventive care may be beneficial in this patient population.
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Affiliation(s)
- Gonzalo Salazar de Pablo
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, King’s College London, London, United Kingdom,Institute of Psychiatry and Mental Health, Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain,Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Joaquim Radua
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, King’s College London, London, United Kingdom,Imaging of Mood- and Anxiety-Related Disorders (IMARD) Group, Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain,Department of Clinical Neuroscience, Centre for Psychiatric Research and Education, Karolinska Institutet, Stockholm, Sweden
| | - Joana Pereira
- Centro Hospitalar Psiquiátrico de Lisboa, Lisbon, Portugal
| | - Ilaria Bonoldi
- Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, King’s College London, London, United Kingdom
| | - Vincenzo Arienti
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Filippo Besana
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Livia Soardo
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Anna Cabras
- Department of Neurology and Psychiatry, University of Rome La Sapienza, Rome, Italy
| | - Lydia Fortea
- Imaging of Mood- and Anxiety-Related Disorders (IMARD) Group, Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain,Institute of Neurosciences, University of Barcelona, Barcelona, Spain
| | - Ana Catalan
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, King’s College London, London, United Kingdom,Mental Health Department, Biocruces Bizkaia Health Research Institute, Basurto University Hospital, Facultad de Medicina y Odontología, Campus de Leioa, University of the Basque Country, UPV/EHU, Bizkaia, Spain
| | - Julio Vaquerizo-Serrano
- Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, King’s College London, London, United Kingdom,Institute of Psychiatry and Mental Health, Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain,Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Francesco Coronelli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Simi Kaur
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, King’s College London, London, United Kingdom
| | - Josette Da Silva
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, King’s College London, London, United Kingdom
| | - Jae Il Shin
- Department of Paediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Marco Solmi
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, King’s College London, London, United Kingdom,Neurosciences Department, University of Padova, Padova, Italy
| | - Natascia Brondino
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Pierluigi Politi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Philip McGuire
- Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, King’s College London, London, United Kingdom,OASIS service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, King’s College London, London, United Kingdom,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy,OASIS service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
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8
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Mei C, van der Gaag M, Nelson B, Smit F, Yuen HP, Berger M, Krcmar M, French P, Amminger GP, Bechdolf A, Cuijpers P, Yung AR, McGorry PD. Preventive interventions for individuals at ultra high risk for psychosis: An updated and extended meta-analysis. Clin Psychol Rev 2021; 86:102005. [PMID: 33810885 DOI: 10.1016/j.cpr.2021.102005] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 01/14/2021] [Accepted: 03/01/2021] [Indexed: 02/06/2023]
Abstract
Intervention at the earliest illness stage, in ultra or clinical high-risk individuals, or indicated prevention, currently represents the most promising strategy to ameliorate, delay or prevent psychosis. We review the current state of evidence and conduct a broad-spectrum meta-analysis of various outcomes: transition to psychosis, attenuated positive and negative psychotic symptoms, mania, depression, anxiety, general psychopathology, symptom-related distress, functioning, quality of life, and treatment acceptability. 26 randomized controlled trials were included. Meta-analytically pooled interventions reduced transition rate (risk ratio [RR] = 0.57, 95%CI 0.41-0.81) and attenuated positive psychotic symptoms at 12-months (standardized mean difference = -0.15, 95%CI = -0.28--0.01). When stratified by intervention type (pharmacological, psychological), only the pooled effect of psychological interventions on transition rate was significant. Cognitive behavioral therapy (CBT) was associated with a reduction in incidence at 12-months (RR = 0.52, 95%CI = 0.33-0.82) and 18-48-months (RR = 0.60, 95%CI = 0.42-0.84), but not 6-months. Findings at 12-months and 18-48-months were robust in sensitivity and subgroup analyses. All other outcomes were non-significant. To date, effects of trialed treatments are specific to transition and, a lesser extent, attenuated positive symptoms, highlighting the future need to target other symptom domains and functional outcomes. Sound evidence supports CBT in reducing transition and the value of intervening at this illness stage. STUDY REGISTRATION: Research Registry ID: reviewregistry907.
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Affiliation(s)
- Cristina Mei
- Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Mark van der Gaag
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Parnassia Psychiatric Institute, The Hague, the Netherlands.
| | - Barnaby Nelson
- Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Filip Smit
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Centre of Mental Health and Prevention, Utrecht, the Netherlands; Department of Epidemiology and Biostatistics, Amsterdam University Medical Centres, Amsterdam, the Netherlands
| | - Hok Pan Yuen
- Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Maximus Berger
- Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Marija Krcmar
- Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Paul French
- School of Health Sciences, University of Manchester, Manchester, UK
| | - G Paul Amminger
- Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Andreas Bechdolf
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Vivantes Klinikum am Urban, Charite-Universitätsmedizin, Berlin, Germany; Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Alison R Yung
- Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia; School of Health Sciences, University of Manchester, Manchester, UK
| | - Patrick D McGorry
- Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.
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9
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The Relationship between PID-5 Personality Traits and Mental States. A Study on a Group of Young Adults at Risk of Psychotic Onset. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57010033. [PMID: 33401519 PMCID: PMC7823839 DOI: 10.3390/medicina57010033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 12/26/2020] [Accepted: 12/29/2020] [Indexed: 01/10/2023]
Abstract
Background and Objectives: The diagnosis of psychosis is a challenge for the scientific community, both in terms of its definition and treatment. Some recent studies have investigated the relationship between personality and psychosis onset to prevent or intervene early. Materials and Methods: Sixty young adults were recruited during their first access in 2019 near the Community Mental Health Service of Niguarda Hospital, Milan, Italy. The assessment included the Social and Occupational Functioning Assessment Scale (SOFAS), the Global Assessment of Functioning (GAF) (clinician scales), the 16-item Version of the Prodromal Questionnaire (PQ-16), the Personality Inventory for DSM-5 (PID-5) (self-report), and a clinical session. Statistical analysis was performed by SPSS. Results: The results show a negative correlation between the Detachment domain and the GAF scores. Correlational analysis also highlights that all PID-5 domains, except for Antagonism, have positive correlations with high scores in the PQ-16. The multivariate analysis of variance showed that patients diagnosed with versus without a psychotic disorder significantly differed on Detachment, Antagonism and Psychoticism PID-5 domains. Conclusions: The involvement of the personality construct in psychopathological development is displayed. In particular, higher levels of Detachment and Psychoticism can distinguish people who are more vulnerable to psychosis or who already have overt psychosis from those who do not have a psychotic predisposition. The study highlights the fundamental role of personality traits, emerging from PID-5, to distinguish young adults at risk of onset.
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10
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Mensi MM, Rogantini C, Nacinovich R, Riva A, Provenzi L, Chiappedi M, Balottin U, Borgatti R. Clinical features of adolescents diagnosed with eating disorders and at risk for psychosis. EUROPEAN PSYCHIATRY : THE JOURNAL OF THE ASSOCIATION OF EUROPEAN PSYCHIATRISTS 2020. [PMID: 32829729 DOI: 10.1192/j.eurp-sy.2020.80] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The presence of subthreshold psychotic symptoms in adolescents with eating disorders is poorly described. This study provides a detailed characterization of adolescents affected by eating disorders in the absence or presence of subthreshold psychotic symptoms, taking into account a wide set of sociodemographic, psychological, and clinical variables. METHODS Ninety-four adolescents diagnosed with eating disorders were interviewed, focusing on clinical anamnesis and sociodemographic data collection. The Comprehensive Assessment of At-Risk Mental States (CAARMS) was used to assess the presence (HR+) or absence (HR-) of subthreshold psychosis. The clinicians completed a questionnaire on eating disorders severity, whereas patients provided self-report measures of global social functioning and psychological symptoms associated with eating disorders. RESULTS Attenuated psychotic symptoms were highly frequent (84% of subjects). HR+ patients experienced more frequently purging behaviors and dysmorphophobia and received a greater amount of antipsychotic drugs. Compared to HR- counterparts, HR+ patients reported higher eating disorders severity and psychological symptoms (i.e., ineffectiveness, interpersonal and affective problems) associated with eating disorders. Finally, a significant correlation between global social functioning and eating disorders severity emerged only for HR- subjects. CONCLUSIONS These descriptive data are warranted to identify a potential psychotic core in eating disorders, mainly concerning body image and weight as well as specific psychological features. The availability of reliable and valid markers of risk can further increase our capacity to detect the early emergence of psychosis in adolescents with eating disorders, whose outcome might be worsened by the presence of psychotic symptoms.
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Affiliation(s)
- Martina Maria Mensi
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy.,Child Neurology and Psychiatry Unit, Brain and Behavioral Sciences Department, University of Pavia, Pavia, Italy
| | - Chiara Rogantini
- Child Neurology and Psychiatry Unit, Brain and Behavioral Sciences Department, University of Pavia, Pavia, Italy
| | - Renata Nacinovich
- Child and Adolescent Mental Health, San Gerardo Hospital, Monza, Italy.,School of Medicine and Surgery and Milan Center for Neuroscience, University of Milano Bicocca, Milano, Italy
| | - Anna Riva
- Child and Adolescent Mental Health, San Gerardo Hospital, Monza, Italy
| | - Livio Provenzi
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Matteo Chiappedi
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Umberto Balottin
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy.,Child Neurology and Psychiatry Unit, Brain and Behavioral Sciences Department, University of Pavia, Pavia, Italy
| | - Renato Borgatti
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy.,Child Neurology and Psychiatry Unit, Brain and Behavioral Sciences Department, University of Pavia, Pavia, Italy
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11
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Mensi MM, Rogantini C, Nacinovich R, Riva A, Provenzi L, Chiappedi M, Balottin U, Borgatti R. Clinical features of adolescents diagnosed with eating disorders and at risk for psychosis. Eur Psychiatry 2020; 63:e80. [PMID: 32829729 PMCID: PMC7503175 DOI: 10.1192/j.eurpsy.2020.80] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The presence of subthreshold psychotic symptoms in adolescents with eating disorders is poorly described. This study provides a detailed characterization of adolescents affected by eating disorders in the absence or presence of subthreshold psychotic symptoms, taking into account a wide set of sociodemographic, psychological, and clinical variables. METHODS Ninety-four adolescents diagnosed with eating disorders were interviewed, focusing on clinical anamnesis and sociodemographic data collection. The Comprehensive Assessment of At-Risk Mental States (CAARMS) was used to assess the presence (HR+) or absence (HR-) of subthreshold psychosis. The clinicians completed a questionnaire on eating disorders severity, whereas patients provided self-report measures of global social functioning and psychological symptoms associated with eating disorders. RESULTS Attenuated psychotic symptoms were highly frequent (84% of subjects). HR+ patients experienced more frequently purging behaviors and dysmorphophobia and received a greater amount of antipsychotic drugs. Compared to HR- counterparts, HR+ patients reported higher eating disorders severity and psychological symptoms (i.e., ineffectiveness, interpersonal and affective problems) associated with eating disorders. Finally, a significant correlation between global social functioning and eating disorders severity emerged only for HR- subjects. CONCLUSIONS These descriptive data are warranted to identify a potential psychotic core in eating disorders, mainly concerning body image and weight as well as specific psychological features. The availability of reliable and valid markers of risk can further increase our capacity to detect the early emergence of psychosis in adolescents with eating disorders, whose outcome might be worsened by the presence of psychotic symptoms.
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Affiliation(s)
- Martina Maria Mensi
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy.,Child Neurology and Psychiatry Unit, Brain and Behavioral Sciences Department, University of Pavia, Pavia, Italy
| | - Chiara Rogantini
- Child Neurology and Psychiatry Unit, Brain and Behavioral Sciences Department, University of Pavia, Pavia, Italy
| | - Renata Nacinovich
- Child and Adolescent Mental Health, San Gerardo Hospital, Monza, Italy.,School of Medicine and Surgery and Milan Center for Neuroscience, University of Milano Bicocca, Milano, Italy
| | - Anna Riva
- Child and Adolescent Mental Health, San Gerardo Hospital, Monza, Italy
| | - Livio Provenzi
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Matteo Chiappedi
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Umberto Balottin
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy.,Child Neurology and Psychiatry Unit, Brain and Behavioral Sciences Department, University of Pavia, Pavia, Italy
| | - Renato Borgatti
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy.,Child Neurology and Psychiatry Unit, Brain and Behavioral Sciences Department, University of Pavia, Pavia, Italy
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12
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Nelson B, Yuen HP, Amminger GP, Berger G, Chen EYH, de Haan L, Hartmann JA, Hickie IB, Lavoie S, Markulev C, Mossaheb N, Nieman DH, Nordentoft M, Polari A, Riecher-Rössler A, Schäfer MR, Schlögelhofer M, Smesny S, Tedja A, Thompson A, Verma S, Yung AR, McGorry PD. Distress related to attenuated psychotic symptoms: Static and dynamic association with transition to psychosis, non-remission and transdiagnostic symptomatology in clinical high-risk patients in an international intervention trial. ACTA ACUST UNITED AC 2020. [DOI: 10.1093/schizbullopen/sgaa006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
This study examined whether distress in relation to attenuated psychotic symptoms (DAPS) is associated with clinical outcomes in an ultra-high-risk (UHR) for psychosis sample. We also investigated whether DAPS is associated with cognitive style (attributional style and cognitive biases) and whether amount of psychosocial treatment provided is associated with reduction in DAPS. The study was a secondary analysis of the ‘Neurapro’ clinical trial of omega-3 fatty acids. 304 UHR patients were recruited across ten early intervention services. Data from baseline assessment, regular assessments over 12 months and medium term follow up (mean=3.4 years) were used for analysis. Findings indicated: a positive association between DAPS assessed over time and transition to psychosis; a significant positive association between baseline and longitudinal DAPS and transdiagnostic clinical and functional outcomes; a significant positive association between baseline and longitudinal DAPS and non-remission of UHR status. There was no relationship between severity of DAPS and cognitive style. A greater amount of psychosocial treatment (cognitive-behavioural case management) was associated with an increase in DAPS scores. The study indicates that UHR patients who are more distressed by their attenuated psychotic symptoms are more likely to have a poorer clinical trajectory transdiagnostically. Assessment of DAPS may therefore function as a useful marker of risk for a range of poor outcomes. The findings underline the value of repeated assessment of variables and incorporation of dynamic change into predictive modelling. More research is required into mechanisms driving distress associated with symptoms and the possible bidirectional relationship between symptom severity and associated distress.
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Affiliation(s)
- B Nelson
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - H P Yuen
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - G P Amminger
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - G Berger
- Child and Adolescent Psychiatric Service of the Canton of Zurich, Zurich, Switzerland
| | - E Y H Chen
- Department of Psychiatry, University of Hong Kong, Hong Kong
| | - L de Haan
- Academic Medical Center, Amsterdam, the Netherlands
| | - J A Hartmann
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - I B Hickie
- Brain and Mind Research Institute, University of Sydney, Australia
| | - S Lavoie
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - C Markulev
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - N Mossaheb
- Department of Psychiatry and Psychotherapy, Clinical Division of Social Psychiatry, Medical University of Vienna, Austria
| | - D H Nieman
- Academic Medical Center, Amsterdam, the Netherlands
| | - M Nordentoft
- CORE-Copenhagen Research Centre for Mental Health, Mental Health Centre Copenhagen, Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - A Polari
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | | | - M R Schäfer
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - M Schlögelhofer
- Department of Child and Adolescent Psychiatry, Medical University Vienna, Austria
| | - S Smesny
- University Hospital Jena, Jena, Germany
| | - A Tedja
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - A Thompson
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - S Verma
- Institute of Mental Health, Singapore, Singapore
| | - A R Yung
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - P D McGorry
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
- Department of Psychology, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne
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