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Wang F, Huang ZH, Ye Y, He XY, Wang SB, Jia FJ, Hou CL. Genome-wide association exploratory studies in individuals with ultra-high risk for schizophrenia in Chinese Han nationality in two years follow-up: A subpopulation study. Asian J Psychiatr 2024; 97:104071. [PMID: 38810489 DOI: 10.1016/j.ajp.2024.104071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 04/27/2024] [Accepted: 05/11/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Although ultra-high risk for schizophrenia (UHR) is related to both genetic and environment factors, the precise pathogenesis is still unknow. To date, few studies have explored the Genome-Wide Association Studies (GWAS) in UHR or HR individuals especially in Han population in China. METHODS In this study, a GWAS analysis for 36 participants with UHR and 43 with HR were performed, and all deletion variations in 22q11 region were also compared. RESULTS Sixteen individuals with UHR (44.4%) and none with HR converted into schizophrenia in follow-up after two years. Six loci including neurexin-1(NRXN1) (rs1045881), dopamine D1 receptor (DRD1) (rs686, rs4532), chitinase-3-like protein 1 (CHI3L1) (rs4950928), velocardiofacial syndrome (ARVCF) (rs165815), dopamine D2 receptor (DRD2) (rs1076560) were identified higher expression with significant difference in individuals converted into schizophrenia after two years. The Family with Sequence Similarity 230 Member H (FAM230H) gene in the 22q11 region were also found high expression in UHR group. CONCLUSIONS Further expansion of sample size and validation studies are needed to explore the pathogenesis of these risk loci in UHR conversion into schizophrenia in the future.
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Affiliation(s)
- Fei Wang
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Zhuo-Hui Huang
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Ye Ye
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Xiao-Yan He
- Wuxi Mental Health Center, Jiangsu Province 214151, China
| | - Shi-Bin Wang
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Fu-Jun Jia
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Cai-Lan Hou
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China.
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Mourad M, Atallah EP, Raad G, Haddad R, Richa S. Effectiveness of a two-stage strategy using the 16-item Prodromal Questionnaire (PQ16/fPQ16) and the Comprehensive Assessment of At Risk Mental States (CAARMS) in the early detection of Ultra High Risk (UHR) patients in Lebanon: a cross-sectional pilot study. L'ENCEPHALE 2024; 50:40-47. [PMID: 36717331 DOI: 10.1016/j.encep.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 11/23/2022] [Indexed: 01/30/2023]
Abstract
OBJECTIVES This study aims to identify the prevalence of Ultra High Risk (UHR) adults in a sample of patients in Lebanon and to compare screening and diagnostic tools. METHODS This is a cross-sectional pilot study which targeted patients aged 17-30 years willingly seeking psychiatric care in a university hospital in Beirut, Lebanon. Participants were invited to fill either the English or the French version of the Prodromal Questionnaire (respectively, PQ16 or fPQ16). The abbreviated version of the "Comprehensive Assessment of At-Risk Mental States" (CAARMS) was then administered to all participants. The latter were subsequently sorted into one of the three UHR groups - vulnerability group, attenuated psychosis (APS), intermittent psychosis (BLIPS) - or were diagnosed as suffering from a psychotic disorder. RESULTS Thirty-one patients participated in this study. The prevalence of positive screening on the PQ16/fPQ16 and positive diagnosis of UHR on the CAARMS were respectively of 61.29% and 45%. The APS group was the most prevalent (71.42%). A positive psychosis screening on PQ16/fPQ16 was statistically related to a UHR diagnosis on CAARMS (p-value: 0.011 on Chi2 test), OR=8.5 (95% CI: 1.4-50.9; p-value: 0.018). No relation was found between PQ16/fPQ16 results and risk stratification or between the number of "True" responses on PQ16/fPQ16 and the intensity of symptoms on CAARMS. PQ16/fPQ16 statements 5, 9, 11 and 16 predicted a UHR diagnosis on CAARMS (p-value of 0.045, 0.006, 0.045 and 0.045, respectively). CONCLUSION This two-stage strategy for identifying UHR patients can be adopted in a tertiary health care center.
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Affiliation(s)
- M Mourad
- Department of Psychiatry, University Hospital Center, Hôtel-Dieu de France, Saint Joseph University of Beirut, Beirut, Lebanon; Department of Psychiatry, Faculty of Medicine, Saint Joseph University of Beirut, Beirut, Lebanon
| | - E P Atallah
- Department of Psychiatry, University Hospital Center, Hôtel-Dieu de France, Saint Joseph University of Beirut, Beirut, Lebanon; Department of Psychiatry, Faculty of Medicine, Saint Joseph University of Beirut, Beirut, Lebanon.
| | - G Raad
- Department of Psychiatry, University Hospital Center, Hôtel-Dieu de France, Saint Joseph University of Beirut, Beirut, Lebanon; School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh, Lebanon
| | - R Haddad
- Department of Psychiatry, Faculty of Medicine, Saint Joseph University of Beirut, Beirut, Lebanon; Department of Psychiatry, Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon
| | - S Richa
- Department of Psychiatry, University Hospital Center, Hôtel-Dieu de France, Saint Joseph University of Beirut, Beirut, Lebanon; Department of Psychiatry, Faculty of Medicine, Saint Joseph University of Beirut, Beirut, Lebanon
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Lee TY, Hwang WJ, Kim NS, Park I, Lho SK, Moon SY, Oh S, Lee J, Kim M, Woo CW, Kwon JS. Prediction of psychosis: model development and internal validation of a personalized risk calculator. Psychol Med 2022; 52:2632-2640. [PMID: 33315005 PMCID: PMC9647536 DOI: 10.1017/s0033291720004675] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 11/04/2020] [Accepted: 11/11/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Over the past two decades, early detection and early intervention in psychosis have become essential goals of psychiatry. However, clinical impressions are insufficient for predicting psychosis outcomes in clinical high-risk (CHR) individuals; a more rigorous and objective model is needed. This study aims to develop and internally validate a model for predicting the transition to psychosis within 10 years. METHODS Two hundred and eight help-seeking individuals who fulfilled the CHR criteria were enrolled from the prospective, naturalistic cohort program for CHR at the Seoul Youth Clinic (SYC). The least absolute shrinkage and selection operator (LASSO)-penalized Cox regression was used to develop a predictive model for a psychotic transition. We performed k-means clustering and survival analysis to stratify the risk of psychosis. RESULTS The predictive model, which includes clinical and cognitive variables, identified the following six baseline variables as important predictors: 1-year percentage decrease in the Global Assessment of Functioning score, IQ, California Verbal Learning Test score, Strange Stories test score, and scores in two domains of the Social Functioning Scale. The predictive model showed a cross-validated Harrell's C-index of 0.78 and identified three subclusters with significantly different risk levels. CONCLUSIONS Overall, our predictive model showed a predictive ability and could facilitate a personalized therapeutic approach to different risks in high-risk individuals.
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Affiliation(s)
- Tae Young Lee
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Psychiatry, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Wu Jeong Hwang
- Department of Brain and Cognitive Neuroscience, Seoul National University College of Natural Sciences, Seoul, Republic of Korea
- Center for Neuroscience Imaging Research, Institute for Basic Science, Suwon, Republic of Korea
| | - Nahrie S. Kim
- Department of Psychiatry, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
- Department of Brain and Cognitive Neuroscience, Seoul National University College of Natural Sciences, Seoul, Republic of Korea
- Center for Neuroscience Imaging Research, Institute for Basic Science, Suwon, Republic of Korea
| | - Inkyung Park
- Department of Brain and Cognitive Neuroscience, Seoul National University College of Natural Sciences, Seoul, Republic of Korea
- Center for Neuroscience Imaging Research, Institute for Basic Science, Suwon, Republic of Korea
| | - Silvia Kyungjin Lho
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sun-Young Moon
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sanghoon Oh
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Junhee Lee
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Minah Kim
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Choong-Wan Woo
- Department of Brain and Cognitive Neuroscience, Seoul National University College of Natural Sciences, Seoul, Republic of Korea
- Center for Neuroscience Imaging Research, Institute for Basic Science, Suwon, Republic of Korea
- Department of Biomedical Engineering, Sungkyunkwan University, Suwon, Republic of Korea
| | - Jun Soo Kwon
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Brain and Cognitive Neuroscience, Seoul National University College of Natural Sciences, Seoul, Republic of Korea
- Center for Neuroscience Imaging Research, Institute for Basic Science, Suwon, Republic of Korea
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Hedges EP, Dickson H, Tognin S, Modinos G, Antoniades M, van der Gaag M, de Haan L, McGorry P, Pantelis C, Riecher-Rössler A, Bressan R, Barrantes-Vidal N, Krebs MO, Nordentoft M, Ruhrmann S, Sachs G, Rutten BP, van Os J, Valmaggia LR, McGuire P, Kempton MJ. Verbal memory performance predicts remission and functional outcome in people at clinical high-risk for psychosis. Schizophr Res Cogn 2022; 28:100222. [PMID: 35242602 PMCID: PMC8861401 DOI: 10.1016/j.scog.2021.100222] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 10/11/2021] [Accepted: 10/11/2021] [Indexed: 10/26/2022]
Abstract
Robust deficits in cognitive functioning are present in people with psychosis and are evident in the early stages of the disorder. Impairments in verbal memory and verbal fluency are reliably seen in individuals at clinical high-risk for psychosis (CHR) compared to healthy populations. As previous studies have shown a relationship between cognition and longer-term outcomes in schizophrenia, the aim of this paper was to explore whether verbal memory and verbal fluency performance predicted outcomes in a large CHR sample recruited as part of the EU-GEI High Risk Study. Participants included 316 CHR individuals, 90.8% of whom were not currently on antipsychotic medication, and 60 healthy controls. Verbal memory and verbal fluency performance were measured at baseline. At two-year follow-up, CHR individuals were assessed by three different outcome measures, those who did and did not (1) transition to psychosis, (2) experience burdening impairment or disabilities, or (3) remit clinically from CHR status. Individuals with CHR displayed significant verbal memory and verbal fluency deficits at baseline compared to healthy controls (Hedges' g effect size = 0.24 to 0.66). There were no significant differences in cognitive performance of those who did and did not transition to psychosis. However, impaired immediate verbal recall predicted both functional disability and non-remission from the CHR state. Results remained significant when analyses were restricted to only include antipsychotic-free CHR participants. These findings may inform the development of early interventions designed to improve cognitive deficits in the early stages of psychosis.
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Affiliation(s)
- Emily P. Hedges
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom
- Corresponding author at: Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, SE5 8AF, United Kingdom.
| | - Hannah Dickson
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom
| | - Stefania Tognin
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom
| | - Gemma Modinos
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom
| | - Mathilde Antoniades
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1425 Madison Ave, New York, NY 10029, United States
| | - Mark van der Gaag
- VU University, Faculty of Behavioural and Movement Sciences, Department of Clinical Psychology and EMGO+ Institute for Health and Care Research, van der Boechorststraat 1, 1081, BT, Amsterdam, the Netherlands
- Parnassia Psychiatric Institute, Department of Psychosis Research, Zoutkeetsingel 40, 2512, HN, The Hague, the Netherlands
| | - Lieuwe de Haan
- Amsterdam UMC, Department Early Psychosis, Meibergdreef 5, 1105, AZ, Amsterdam, the Netherlands
- Arkin Amsterdam, the Netherlands
| | - Patrick McGorry
- Centre for Youth Mental Health, University of Melbourne, 35 Poplar Road (Locked Bag 10), Parkville, Victoria 485 3052, Australia
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, University of Melbourne & Melbourne Health, Carlton South, Vic, Australia
| | | | - Rodrigo Bressan
- LiNC - Lab Interdisciplinar Neurociências Clínicas, Depto Psiquiatria, Escola Paulista de Medicina, Universidade Federal de São Paulo – UNIFESP, 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), Spain
| | - Marie-Odile Krebs
- University of Paris, GHU Psychiatrie et Neurosciences of Paris, Sainte-Anne, C’JAAD, pôle PEPIT, Inserm 1266, Institut de Psychiatrie (CNRS 3557), Paris, France
| | - 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, Denmark
| | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Gabriele Sachs
- Medical University of Vienna, Department of Psychiatry and Psychotherapy, Austria
| | - Bart P. Rutten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, P.O. Box 616, 6200 MD 464 Maastricht, the Netherlands
| | - Jim van Os
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, P.O. Box 616, 6200 MD 464 Maastricht, the Netherlands
| | | | - Lucia R. Valmaggia
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom
| | - Matthew J. Kempton
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom
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Worthington MA, Addington J, Bearden CE, Cadenhead KS, Cornblatt BA, Keshavan M, Mathalon DH, McGlashan TH, Perkins DO, Stone WS, Tsuang MT, Walker EF, Woods SW, Cannon TD. Individualized Prediction of Prodromal Symptom Remission for Youth at Clinical High Risk for Psychosis. Schizophr Bull 2021; 48:395-404. [PMID: 34581405 PMCID: PMC8886593 DOI: 10.1093/schbul/sbab115] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The clinical high-risk period before a first episode of psychosis (CHR-P) has been widely studied with the goal of understanding the development of psychosis; however, less attention has been paid to the 75%-80% of CHR-P individuals who do not transition to psychosis. It is an open question whether multivariable models could be developed to predict remission outcomes at the same level of performance and generalizability as those that predict conversion to psychosis. Participants were drawn from the North American Prodrome Longitudinal Study (NAPLS3). An empirically derived set of clinical and demographic predictor variables were selected with elastic net regularization and were included in a gradient boosting machine algorithm to predict prodromal symptom remission. The predictive model was tested in a comparably sized independent sample (NAPLS2). The classification algorithm developed in NAPLS3 achieved an area under the curve of 0.66 (0.60-0.72) with a sensitivity of 0.68 and specificity of 0.53 when tested in an independent external sample (NAPLS2). Overall, future remitters had lower baseline prodromal symptoms than nonremitters. This study is the first to use a data-driven machine-learning approach to assess clinical and demographic predictors of symptomatic remission in individuals who do not convert to psychosis. The predictive power of the models in this study suggest that remission represents a unique clinical phenomenon. Further study is warranted to best understand factors contributing to resilience and recovery from the CHR-P state.
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Affiliation(s)
| | - Jean Addington
- Department of Psychiatry, Hotchkiss Brain Institute, Calgary, AB, Canada
| | - Carrie E Bearden
- Department of Psychiatry and Biobehavioral Sciences and Psychology, UCLA, Los Angeles, CA, USA
| | | | | | - Matcheri Keshavan
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Daniel H Mathalon
- Department of Psychiatry, UCSF, and SFVA Medical Center, San Francisco, CA, USA
| | | | - Diana O Perkins
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - William S Stone
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Elaine F Walker
- Department of Psychology and Psychiatry, Emory University, Atlanta, GA, USA
| | - Scott W Woods
- Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Tyrone D Cannon
- Department of Psychology, Yale University, New Haven, CT, USA,Department of Psychiatry, Yale University, New Haven, CT, USA,To whom correspondence should be addressed; 2 Hillhouse Avenue, PO Box 208205, New Haven, CT 06511, USA; tel: 203-436-1545, fax: 203-432-5281, e-mail:
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6
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Worthington MA, Cannon TD. Prediction and Prevention in the Clinical High-Risk for Psychosis Paradigm: A Review of the Current Status and Recommendations for Future Directions of Inquiry. Front Psychiatry 2021; 12:770774. [PMID: 34744845 PMCID: PMC8569129 DOI: 10.3389/fpsyt.2021.770774] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 09/27/2021] [Indexed: 11/13/2022] Open
Abstract
Prediction and prevention of negative clinical and functional outcomes represent the two primary objectives of research conducted within the clinical high-risk for psychosis (CHR-P) paradigm. Several multivariable "risk calculator" models have been developed to predict the likelihood of developing psychosis, although these models have not been translated to clinical use. Overall, less progress has been made in developing effective interventions. In this paper, we review the existing literature on both prediction and prevention in the CHR-P paradigm and, primarily, outline ways in which expanding and combining these paths of inquiry could lead to a greater improvement in individual outcomes for those most at risk.
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Affiliation(s)
| | - Tyrone D Cannon
- Department of Psychology, Yale University, New Haven, CT, United States.,Department of Psychiatry, Yale University, New Haven, CT, United States
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