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Fusar-Poli P, Estradé A, Esposito CM, Rosfort R, Basadonne I, Mancini M, Stanghellini G, Otaiku J, Olanrele O, Allen L, Lamba M, Alaso C, Ieri J, Atieno M, Oluoch Y, Ireri P, Tembo E, Phiri IZ, Nkhoma D, Sichone N, Siadibbi C, Sundi PRIO, Ntokozo N, Fusar-Poli L, Floris V, Mensi MM, Borgatti R, Damiani S, Provenzani U, Brondino N, Bonoldi I, Radua J, Cooper K, Shin JI, Cortese S, Danese A, Bendall S, Arango C, Correll CU, Maj M. The lived experience of mental disorders in adolescents: a bottom-up review co-designed, co-conducted and co-written by experts by experience and academics. World Psychiatry 2024; 23:191-208. [PMID: 38727047 PMCID: PMC11083893 DOI: 10.1002/wps.21189] [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] [Indexed: 05/13/2024] Open
Abstract
We provide here the first bottom-up review of the lived experience of mental disorders in adolescents co-designed, co-conducted and co-written by experts by experience and academics. We screened first-person accounts within and outside the medical field, and discussed them in collaborative workshops involving numerous experts by experience - representing different genders, ethnic and cultural backgrounds, and continents - and their family members and carers. Subsequently, the material was enriched by phenomenologically informed perspectives and shared with all collaborators. The inner subjective experience of adolescents is described for mood disorders, psychotic disorders, attention-deficit/hyperactivity disorder, autism spectrum disorders, anxiety disorders, eating disorders, externalizing disorders, and self-harm behaviors. The recollection of individuals' past histories also indexes the prodromal (often transdiagnostic) features predating the psychiatric diagnosis. The experience of adolescents with mental disorders in the wider society is described with respect to their family, their school and peers, and the social and cultural context. Furthermore, their lived experience of mental health care is described with respect to receiving a diagnosis of mental disorder, accessing mental health support, receiving psychopharmacological treatment, receiving psychotherapy, experiencing peer support and mental health activism, and achieving recovery. These findings can impact clinical practice, research, and the whole society. We hope that this co-designed, co-conducted and co-written journey can help us maintain our commitment to protecting adolescents' fragile mental health, and can help them develop into a healthy, fulfilling and contributing adult life.
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Affiliation(s)
- Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, King's College London, London, UK
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilian-University, Munich, Germany
| | - Andrés Estradé
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, King's College London, London, UK
| | - Cecilia M Esposito
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - René Rosfort
- S. Kierkegaard Research Centre, University of Copenhagen, Copenhagen, Denmark
| | - Ilaria Basadonne
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Milena Mancini
- Department of Psychological Sciences, Health and Territory, G. D'Annunzio University of Chieti and Pescara, Chieti, Italy
| | - Giovanni Stanghellini
- Department of Health Sciences, University of Florence, Florence, Italy
- Diego Portales University, Santiago, Chile
| | - Jummy Otaiku
- Young Person's Mental Health Advisory Group, King's College London, London, UK
| | | | - Lucas Allen
- OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK
| | | | | | - Judy Ieri
- Global Mental Health Peer Network, Nairobi, Kenya
| | | | | | - Phides Ireri
- Global Mental Health Peer Network, Nairobi, Kenya
| | - Ephraim Tembo
- Global Mental Health Peer Network, Lusaka, Zambia
- University of Zambia, Lusaka, Zambia
| | | | | | - Noah Sichone
- Global Mental Health Peer Network, Lusaka, Zambia
| | - Candy Siadibbi
- Global Mental Health Peer Network, Lusaka, Zambia
- Psychology Association of Zambia, Lusaka, Zambia
| | | | - Nyathi Ntokozo
- Global Mental Health Peer Network, Bulawayo, Zimbabwe
- Youth Support Network Trust, Bulawayo, Zimbabwe
| | - Laura Fusar-Poli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Valentina Floris
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Martina M Mensi
- National Neurological Institute, IRCCS C. Mondino Foundation, Pavia, Italy
| | - Renato Borgatti
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- National Neurological Institute, IRCCS C. Mondino Foundation, Pavia, Italy
| | - Stefano Damiani
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Umberto Provenzani
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Natascia Brondino
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Ilaria Bonoldi
- South London and Maudsley NHS Foundation Trust, London, UK
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Joaquim Radua
- Institut d'Investigacions Biomediques August Pi i Sunyer, CIBERSAM, Instituto de Salud Carlos III, University of Barcelona, Barcelona, Spain
| | - Kate Cooper
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Samuele Cortese
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK
- Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York, NY, USA
- Solent NHS Trust, Southampton, UK
- Department of Precision and Regenerative Medicine and Jonic Area, University of Bari, Bari, Italy
| | - Andrea Danese
- Social, Genetic and Developmental Psychiatry Centre and Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- National and Specialist Child and Adolescent Mental Health Service Clinic for Trauma, Anxiety and Depression, South London and Maudsley NHS Foundation Trust, London, UK
| | - Sarah Bendall
- Orygen, Melbourne, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Celso Arango
- Institute of Psychiatry and Mental Health, Department of Child and Adolescent Psychiatry, Hospital General Universitario G. Marañón, School of Medicine, Universidad Complutense, CIBERSAM, Madrid, Spain
| | - Christoph U Correll
- Department of Child and Adolescent Psychiatry, Universitätsmedizin Berlin, Berlin, Germany
- Departments of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
| | - Mario Maj
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
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Schultze-Lutter F, Banaschewski T, Barth GM, Bechdolf A, Bender S, Flechtner HH, Hackler S, Heuer F, Hohmann S, Holzner L, Huss M, Koutsouleris N, Lipp M, Mandl S, Meisenzahl E, Munz M, Osman N, Peschl J, Reissner V, Renner T, Riedel A, Romanos M, Romer G, Schomerus G, Thiemann U, Uhlhaas PJ, Woopen C, Correll CU, Care-Konsortium D. [Ethical Considerations of Including Minors in Clinical Trials Using the Example of the Indicated Prevention of Psychotic Disorders]. ZEITSCHRIFT FUR KINDER- UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2024. [PMID: 38809160 DOI: 10.1024/1422-4917/a000981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Abstract
Ethical Considerations of Including Minors in Clinical Trials Using the Example of the Indicated Prevention of Psychotic Disorders Abstract: As a vulnerable group, minors require special protection in studies. For this reason, researchers are often reluctant to initiate studies, and ethics committees are reluctant to authorize such studies. This often excludes minors from participating in clinical studies. This exclusion can lead to researchers and clinicians receiving only incomplete data or having to rely on adult-based findings in the treatment of minors. Using the example of the study "Computer-Assisted Risk Evaluation in the Early Detection of Psychotic Disorders" (CARE), which was conducted as an 'other clinical investigation' according to the Medical Device Regulation, we present a line of argumentation for the inclusion of minors which weighs the ethical principles of nonmaleficence (especially regarding possible stigmatization), beneficence, autonomy, and fairness. We show the necessity of including minors based on the development-specific differences in diagnostics and early intervention. Further, we present specific protective measures. This argumentation can also be transferred to other disorders with the onset in childhood and adolescence and thus help to avoid excluding minors from appropriate evidence-based care because of insufficient studies.
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Affiliation(s)
- Frauke Schultze-Lutter
- Klinik für Psychiatrie und Psychotherapie, Medizinische Fakultät und Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
- Department of Psychology, Faculty of Psychology, Airlangga University, Surabaya, Indonesien
- Universitätsklinik für Kinder- und Jugendpsychiatrie und Psychotherapie, Universität Bern, Schweiz
| | - Tobias Banaschewski
- Klinik für Psychiatrie und Psychotherapie des Kindes- und Jugendalters, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Deutschland
| | - Gottfried M Barth
- Abteilung Psychiatrie, Psychosomatik und Psychotherapie im Kindes- und Jugendalter, Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Tübingen, Deutschland
| | - Andreas Bechdolf
- Vivantes Klinikum Am Urban und Vivantes Klinikum im Friedrichshain, Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Berlin, Deutschland
- Klinik für Psychiatrie und Psychotherapie, CCM, Charité - Universitätsmedizin Berlin, Deutschland
- Deutsches Zentrum für Psychische Gesundheit, Standort Berlin, Deutschland
| | - Stephan Bender
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Köln, Deutschland
| | - Hans-Henning Flechtner
- Universitätsklinik für Psychiatrie, Psychotherapie und psychosomatische Medizin des Kindes- und Jugendalters, Otto-von-Guericke Universität Magdeburg, Magdeburg, Deutschland
| | - Sandra Hackler
- Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, LVR-Klinik Bonn, Bonn, Deutschland
| | - Fabiola Heuer
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Charité - Universitätsmedizin Berlin, Deutschland
| | - Sarah Hohmann
- Klinik für Kinder- und Jugendpsychiatrie, -psychotherapie und -psychosomatik, Universitätsklinikums Hamburg-Eppendorf, Hamburg, Deutschland
| | - Laura Holzner
- Vivantes Klinikum Am Urban und Vivantes Klinikum im Friedrichshain, Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Berlin, Deutschland
| | - Michael Huss
- Klinik und Poliklinik für Kinder- und Jugendpsychiatrie und -psychotherapie, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz; Mainz, Deutschland
| | - Nikolaos Koutsouleris
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität München, München, Deutschland
- Max Planck Institute of Psychiatry, Max Planck Fellow Group Precision Psychiatry, München, Deutschland
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Michael Lipp
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Selina Mandl
- Klinik und Poliklinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie der Universität München, Klinikum der Universität München, Deutschland
| | - Eva Meisenzahl
- Klinik für Psychiatrie und Psychotherapie, Medizinische Fakultät und Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - Manuel Munz
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik des Kindes- und Jugendalters des Zentrums für Integrative Psychiatrie, Universitätsklinikum Schleswig-Holstein (UKSH), Campus Kiel, Deutschland
| | - Naweed Osman
- Klinik für Psychiatrie und Psychotherapie, Medizinische Fakultät und Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - Jens Peschl
- Klinik für Psychiatrie und Psychotherapie, Medizinische Fakultät und Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - Volker Reissner
- Abteilung für Kinder- und Jugendpsychiatrie, LVR-Klinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Deutschland
| | - Tobias Renner
- Abteilung Psychiatrie, Psychosomatik und Psychotherapie im Kindes- und Jugendalter, Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Tübingen, Deutschland
| | - Anett Riedel
- Universitätsklinik für Psychiatrie, Psychotherapie und psychosomatische Medizin des Kindes- und Jugendalters, Otto-von-Guericke Universität Magdeburg, Magdeburg, Deutschland
| | - Marcel Romanos
- Klinik und Poliklinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, Universitätsklinikum Würzburg, Deutschland
| | - Georg Romer
- Klinik für Kinder- und Jugendpsychiatrie, -psychosomatik und -psychotherapie, Universitätsklinikum Münster, Deutschland
| | - Georg Schomerus
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universität Leipzig, Leipzig, Deutschland
| | - Ulf Thiemann
- Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, LVR-Klinik Bonn, Bonn, Deutschland
| | - Peter J Uhlhaas
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Charité - Universitätsmedizin Berlin, Deutschland
- Institute of Neuroscience and Psychology, University of Glasgow, UK
| | | | - Christoph U Correll
- Deutsches Zentrum für Psychische Gesundheit, Standort Berlin, Deutschland
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Charité - Universitätsmedizin Berlin, Deutschland
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry and Molecular Medicine, Hempstead, NY, USA
| | - das Care-Konsortium
- Klinik für Psychiatrie und Psychotherapie, Medizinische Fakultät und Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
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Nurminen M. Association of mental health and behavioral disorders with health care and service utilization in children before and after diagnosis. PLoS One 2022; 17:e0278198. [PMID: 36441702 PMCID: PMC9704676 DOI: 10.1371/journal.pone.0278198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 11/11/2022] [Indexed: 11/29/2022] Open
Abstract
Mental health is one of the most important contributors to the global burden of disease in children and adolescents. Mental health conditions are associated with lower quality of life in adulthood. These conditions have an early onset and typically first occur in childhood. However, little is known about how these conditions are related to service utilization before the initial diagnosis, or about the significance of the diagnosis on later service utilization. To study this, register data on 5-15-year-old children in the city of Oulu, Finland, covering the years 2013-2018 were used. To identify the association of mental health and behavioral conditions with service utilization, counterfactuals were constructed from children who were similarly diagnosed three years later. Event study regressions on several health care and service utilization outcomes were estimated. The findings showed that primary and specialized health care utilization increased sharply before the initial diagnosis and peaked during the time of diagnosis. Primary care utilization started decreasing slowly after, while specialized health care utilization remained high for two years after the diagnosis. Probability of visiting a mental health professional, use of rehabilitation services, psychiatric medication, and utilization of child protection services increased significantly after the diagnosis. The results highlighted the importance of outpatient health care in detecting and treating the conditions in children. In a fragmented system, knowledge on utilization trajectories in different services may be of help in allocating resources to improve the health of these children.
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Affiliation(s)
- Mikko Nurminen
- The Social Insurance Institution of Finland (Kela), Helsinki, Finland
- * E-mail:
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Cao XJ, Liu XQ. Artificial intelligence-assisted psychosis risk screening in adolescents: Practices and challenges. World J Psychiatry 2022; 12:1287-1297. [PMID: 36389087 PMCID: PMC9641379 DOI: 10.5498/wjp.v12.i10.1287] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/09/2022] [Accepted: 09/22/2022] [Indexed: 02/05/2023] Open
Abstract
Artificial intelligence-based technologies are gradually being applied to psych-iatric research and practice. This paper reviews the primary literature concerning artificial intelligence-assisted psychosis risk screening in adolescents. In terms of the practice of psychosis risk screening, the application of two artificial intelligence-assisted screening methods, chatbot and large-scale social media data analysis, is summarized in detail. Regarding the challenges of psychiatric risk screening, ethical issues constitute the first challenge of psychiatric risk screening through artificial intelligence, which must comply with the four biomedical ethical principles of respect for autonomy, nonmaleficence, beneficence and impartiality such that the development of artificial intelligence can meet the moral and ethical requirements of human beings. By reviewing the pertinent literature concerning current artificial intelligence-assisted adolescent psychosis risk screens, we propose that assuming they meet ethical requirements, there are three directions worth considering in the future development of artificial intelligence-assisted psychosis risk screening in adolescents as follows: nonperceptual real-time artificial intelligence-assisted screening, further reducing the cost of artificial intelligence-assisted screening, and improving the ease of use of artificial intelligence-assisted screening techniques and tools.
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Affiliation(s)
- Xiao-Jie Cao
- Graduate School of Education, Peking University, Beijing 100871, China
| | - Xin-Qiao Liu
- School of Education, Tianjin University, Tianjin 300350, China
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Holgersen G, Nordgreen T, Ten Velden Hegelstad W, Bircow Elgen I. Views of young people with psychosis on using virtual reality assisted therapy. A qualitative study. Early Interv Psychiatry 2022; 17:361-367. [PMID: 35708166 DOI: 10.1111/eip.13331] [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: 01/11/2022] [Revised: 03/23/2022] [Accepted: 05/29/2022] [Indexed: 11/29/2022]
Abstract
AIM Service disengagement is a challenge in young individuals struggling with psychosis. Combining cognitive behavioural therapy for psychosis (CBTp) with virtual reality (VR) has proven acceptable and potentially effective for symptoms and social functioning in adults with psychosis. However, studies focusing on young adolescents are lacking. The aim of the present study was to investigate the acceptability of VR-assisted CBTp among adolescents with psychosis. METHODS A qualitative study investigating the acceptability of VR during exposure-based social training among adolescents with early onset psychosis. Thematic analysis was used to identify, analyse, interpret and report patterns from the qualitative interviews. RESULTS A total of 27 adolescents with psychosis were invited to participate, 11 declined and 16 were enrolled (59%), and all completed the study. The participants were from 13 until 18 years old, mean age 16 years. None of them had previous experience with use of VR in therapy, but 10 out of 16 participants had prior experience with VR from playing video games. Regarding acceptability, 14 out of 16 had positive expectations towards using VR in CBTp, and they would prefer using VR during exposure-based social training to real-life training only. CONCLUSIONS VR-assisted CBTp can be an acceptable intervention for adolescents with psychosis, given their comfort with technology and the opportunity to confront their fears in less threatening virtual social settings with fewer social risks. The present study yields support to continue developing VR-assisted therapy for adolescents, and focusing on VR-interventions for early onset psychosis.
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Affiliation(s)
- Guri Holgersen
- Department of Child and Adolescent Psychiatry, Haukeland University Hospital, Bergen, Norway.,Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Tine Nordgreen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Wenche Ten Velden Hegelstad
- TIPS Centre for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway.,Faculty of Social Science, Institute for Social Studies, University of Stavanger, Stavanger, Norway
| | - Irene Bircow Elgen
- Department of Child and Adolescent Psychiatry, Haukeland University Hospital, Bergen, Norway.,Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
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de Jong Y, Boon AE, Gouw D, van der Gaag M, Mulder CL. Improving screening methods for psychosis in an adolescent help-seeking population using the Child Behavior Checklist (CBCL) and the Youth Self Report (YSR) versus the Prodromal Questionnaire -16 items version (PQ-16). Child Adolesc Psychiatry Ment Health 2022; 16:25. [PMID: 35361241 PMCID: PMC8973987 DOI: 10.1186/s13034-022-00459-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 03/14/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Screening methods for detecting Ultra High Risk status (UHR) or psychosis should be improved, especially in adolescent samples. We therefore tested whether the Child Behavior Checklist (CBCL) and the Youth Self Report (YSR) add value to the Prodromal Questionnaire-16 items version (PQ-16) for detecting UHR status or psychosis. METHODS We included help-seeking adolescents who had completed the PQ-16, YSR, CBCL, and a Comprehensive Assessment of an At Risk Mental States (CAARMS) interview, and used independent samples t-tests and binary logistic regression analyses to determine the scales contributing to the prediction of UHR status or of having reached the psychosis threshold (PT). Cutoff scores were determined using ROC analyses. RESULTS Our sample comprised 270 help-seeking adolescents (mean age 14.67; SD 1.56, range 12-17); 67.8% were girls and 66.3% were of Dutch origin. The Thought Problems syndrome scales of both the YSR and the CBCL best predicted UHR or PT, and had screening values comparable to the PQ-16. Other syndrome scales did not improve screening values. Although combining measures reduced the number of false negatives, it also increased the number of adolescents to be interviewed. The best choice was to combine the YSR Thought Problems scale and the PQ-16 as a first-step screener. CONCLUSIONS Combining measures improves the detection of UHR or PT in help-seeking adolescents. The Thought Problems subscales of the YSR and CBCL can both be used as a first-step screener in the detection of UHR and/or psychosis. Trial registration Permission was asked according to the rules of the Ethics Committee at Leiden. This study is registered as NL.44180.058.13.
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Affiliation(s)
- Yvonne de Jong
- Parnassia Psychiatric Institute, Rotterdam and The Hague, the Netherlands. .,Department of Psychiatry, Epidemiological and Psychiatric Research Institute, Erasmus MC, Rotterdam, the Netherlands.
| | - Albert E. Boon
- grid.476585.d0000 0004 0447 7260Parnassia Psychiatric Institute, Rotterdam and The Hague, the Netherlands ,grid.10419.3d0000000089452978LUMC Curium - Child and Adolescent Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | - Daniek Gouw
- grid.476585.d0000 0004 0447 7260Parnassia Psychiatric Institute, Rotterdam and The Hague, the Netherlands
| | - Mark van der Gaag
- grid.476585.d0000 0004 0447 7260Parnassia Psychiatric Institute, Rotterdam and The Hague, the Netherlands ,grid.12380.380000 0004 1754 9227Department of Clinical Psychology, Vrije Universiteit, Amsterdam, the Netherlands
| | - Cornelis L. Mulder
- grid.476585.d0000 0004 0447 7260Parnassia Psychiatric Institute, Rotterdam and The Hague, the Netherlands ,grid.5645.2000000040459992XDepartment of Psychiatry, Epidemiological and Psychiatric Research Institute, Erasmus MC, Rotterdam, the Netherlands
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Schultze-Lutter F, Walger P, Franscini M, Traber-Walker N, Osman N, Walger H, Schimmelmann BG, Flückiger R, Michel C. Clinical high-risk criteria of psychosis in 8–17-year-old community subjects and inpatients not suspected of developing psychosis. World J Psychiatry 2022; 12:425-449. [PMID: 35433326 PMCID: PMC8968502 DOI: 10.5498/wjp.v12.i3.425] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 07/26/2021] [Accepted: 09/19/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In children and adolescents compared to adults, clinical high-risk of psychosis (CHR) criteria and symptoms are more prevalent but less psychosis-predictive and less clinically relevant. Based on high rates of non-converters to psychosis, especially in children and adolescents, it was suggested that CHR criteria were: (1) Pluripotential; (2) A transdiagnostic risk factor; and (3) Simply a severity marker of mental disorders rather than specifically psychosis-predictive. If any of these three alternative explanatory models were true, their prevalence should differ between persons with and without mental disorders, and their severity should be associated with functional impairment as a measure of severity.
AIM To compare the prevalence and severity of CHR criteria/symptoms in children and adolescents of the community and inpatients.
METHODS In the mainly cross-sectional examinations, 8–17-year-old community subjects (n = 233) randomly chosen from the population register of the Swiss Canton Bern, and inpatients (n = 306) with primary diagnosis of attention-deficit/hyperactivity disorder (n = 86), eating disorder (n = 97), anxiety including obsessive–compulsive disorder (n = 94), or autism spectrum disorder (n = 29), not clinically suspected to develop psychosis, were examined for CHR symptoms/criteria. Positive items of the Structured Interview for Psychosis-Risk Syndromes (SIPS) were used to assess the symptomatic ultra-high-risk criteria, and the Schizophrenia Proneness Instrument, Child and Youth version (SPI-CY) was used to assess the 14 basic symptoms relevant to basic symptom criteria. We examined group differences in frequency and severity of CHR symptoms/criteria using χ2 tests and nonparametric tests with Cramer’s V and Rosenthal’s r as effect sizes, and their association with functioning using correlation analyses.
RESULTS The 7.3% prevalence rate of CHR criteria in community subjects did not differ significantly from the 9.5% rate in inpatients. Frequency and severity of CHR criteria never differed between the community and the four inpatient groups, while the frequency and severity of CHR symptoms differed only minimally. Group differences were found in only four CHR symptoms: suspiciousness/persecutory ideas of the SIPS [χ2 (4) = 9.425; P = 0.051, Cramer’s V = 0.132; and Z = -4.281, P < 0.001; Rosenthal’s r = 0.184], and thought pressure [χ2 (4) = 11.019; P = 0.026, Cramer’s V = 0.143; and Z = -2.639, P = 0.008; Rosenthal’s r = 0.114], derealization [χ2 (4) = 32.380; P < 0.001, Cramer’s V = 0.245; and Z = -3.924, P < 0.001; Rosenthal’s r = 0.169] and visual perception disturbances [χ2 (4) = 10.652; P = 0.031, Cramer’s V = 0.141; and Z = -2.822, P = 0.005; Rosenthal’s r = 0.122] of the SPI-CY. These were consistent with a transdiagnostic risk factor or dimension, i.e., displayed higher frequency and severity in inpatients, in particular in those with eating, anxiety/obsessive–compulsive and autism spectrum disorders. Low functioning, however, was at most weakly related to the severity of CHR criteria/symptoms, with the highest correlation yielded for suspiciousness/persecutory ideas (Kendall’s tau = -0.172, P < 0.001).
CONCLUSION The lack of systematic differences between inpatients and community subjects does not support suggestions that CHR criteria/symptoms are pluripotential or transdiagnostic syndromes, or merely markers of symptom severity.
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Affiliation(s)
- Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf 40629, North-Rhine Westphalia, Germany
- Department of Psychology, Faculty of Psychology, Airlangga University, Surabaya 60286, Indonesia
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern 3000, Switzerland
| | - Petra Walger
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf 40629, North-Rhine Westphalia, Germany
| | - Maurizia Franscini
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Zürich, Zürich 8032, Germany
| | - Nina Traber-Walker
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Zürich, Zürich 8032, Germany
| | - Naweed Osman
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf 40629, North-Rhine Westphalia, Germany
| | - Helene Walger
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich 80336, Bavaria, Germany
| | - Benno G Schimmelmann
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern 3000, Switzerland
- University Hospital of Child and Adolescent Psychiatry, University Hospital Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Rahel Flückiger
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern 3000, Switzerland
| | - Chantal Michel
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern 3000, Switzerland
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8
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Saxena A, Dodell-Feder D. Explaining the Association Between Urbanicity and Psychotic-Like Experiences in Pre-Adolescence: The Indirect Effect of Urban Exposures. Front Psychiatry 2022; 13:831089. [PMID: 35360125 PMCID: PMC8962621 DOI: 10.3389/fpsyt.2022.831089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 01/27/2022] [Indexed: 11/30/2022] Open
Abstract
Urban living is a growing worldwide phenomenon with more than two-thirds of people expected to live in cities by 2050. Although there are many benefits to living in an urban environment, urbanicity has also been associated with deleterious health outcomes, including increased risk for psychotic outcomes particularly when the urban exposure occurs in pre-adolescence. However, the mechanisms underlying this association is unclear. Here, we utilize one-year follow-up data from a large (N=7,979), nationwide study of pre-adolescence in the United States to clarify why urbanicity (i.e., census-tract population density) might impact psychotic-like experiences (PLE) by looking at the indirect effect of eight candidate urbanicity-related physical (e.g., pollution) and social (e.g., poverty) exposures. Consistent with other work, we found that of the evaluated exposures related to urbanicity, several were also related to increased number of PLE: PM2.5, proximity to roads, census-level homes at-risk for exposure to lead paint, census-level poverty, and census-level income-disparity. These same urban-related exposures were also related to the persistence of PLE after 1 year, but not new onset of PLE. Mediation analysis revealed that a substantial proportion the urbanicity-PLE association (number and persistence) could be explained by PM2.5 (23-44%), families in poverty (68-93%), and income disparity (67-80%). Together, these findings suggest that specific urban-related exposures contribute to the existence and maintenance, but not onset of PLE, which might help to explain why those in urban environments are disproportionately at-risk for psychosis and point toward areas for public health intervention.
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Affiliation(s)
- Abhishek Saxena
- Department of Psychology, University of Rochester, Rochester, NY, United States
| | - David Dodell-Feder
- Department of Psychology, University of Rochester, Rochester, NY, United States
- Department of Neuroscience, University of Rochester Medical Center, Rochester, NY, United States
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9
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Michel C, Kaess M, Flückiger R, Büetiger JR, Schultze-Lutter F, Schimmelmann BG, Gekle W, Jandl M, Hubl D, Kindler J. The Bern Early Recognition and Intervention Centre for mental crisis (FETZ Bern)-An 8-year evaluation. Early Interv Psychiatry 2022; 16:289-301. [PMID: 33960114 DOI: 10.1111/eip.13160] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/12/2021] [Accepted: 04/20/2021] [Indexed: 11/30/2022]
Abstract
AIM Early detection of, and intervention for, psychosis during its prodromal phase has the potential to alter the course of the disease and has therefore become a major objective of modern clinical psychiatry. An increasing number of early detection and intervention services have been established in Europe and worldwide. This study aims to describe and evaluate an early detection and intervention service for children, adolescents and adults (FETZ Bern) aged from eight to 40 years with a population catchment area of 1.035 million in Bern, Switzerland. METHODS Routine demographic, diagnostic and service usage data were collected upon admission to the service. Using a retrospective, descriptive and naturalistic study design, data was analysed for different age groups (children, adolescents and adults) and where available, outcome data after 12 and 24 months was evaluated. RESULTS The FETZ Bern has received 827 referrals with full diagnostic data available for 353 patients. The majority of the assessed patients were young males. While 40% met criteria for a clinical high-risk state of psychosis, 20% were diagnosed with fully manifest psychosis at time of admission, and another 40% had one or more non-psychotic axis-I diagnoses. CONCLUSIONS The FETZ Bern is the first early detection centre worldwide assessing children aged younger than 12 years, as well as adolescents and young adults in one service. Given that developmental peculiarities are important in understanding and ultimately treating psychosis, the FETZ Bern, with its emphasis on developmental peculiarities, should be considered as a model for other similar services.
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Affiliation(s)
- Chantal Michel
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Michael Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.,Section for Translational Psychobiology in Child and Adolescent Psychiatry, Clinic of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Rahel Flückiger
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Jessica R Büetiger
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Frauke Schultze-Lutter
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.,Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Benno G Schimmelmann
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.,University Hospital of Child and Adolescent Psychiatry, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Walter Gekle
- Soteria Bern, Centre for Psychiatric Rehabilitation, Bern, Switzerland
| | - Martin Jandl
- Translational Research Centre, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Daniela Hubl
- Translational Research Centre, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Jochen Kindler
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
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10
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Muñoz-Samons D, Tor J, Rodríguez-Pascual M, Álvarez-Subiela X, Sugranyes G, de la Serna E, Puig O, Dolz M, Baeza I. Recent stressful life events and stress sensitivity in children and adolescents at clinical risk for psychosis. Psychiatry Res 2021; 303:114017. [PMID: 34217983 DOI: 10.1016/j.psychres.2021.114017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 05/16/2021] [Indexed: 12/18/2022]
Abstract
Although psychosocial stress is consistently described as a casual factor for psychosis, the role of recent stressful life events (SLEs) is inconclusive. Studies with subjects with psychosis risk syndrome (PRS), fail to show a large number of SLEs but suggest greater stress sensitivity in these populations. We evaluate the presence of recent SLEs and stress sensitivity, and their relationship with symptoms and functionality in a sample consisting exclusively of help-seeking children and adolescents. Seventy-two 10- to 17-year-old help-seeking subjects who met PRS criteria and forty-two healthy control (HC) subjects participated in a naturalistic multi-site study. Measures of stress included the Stressful Life Events Schedule (SLES) and the G4 item of the Scale for Prodromal Syndromes (SOPS) scale. Child and adolescent PRS subjects presented greater number of SLEs during the previous year, greater total accumulated stress, greater sensitivity to stress, and more impaired tolerance to normal stress than did HC subjects. Stress measures showed a relationship with positive and negative attenuated symptoms, clinical variables and functionality. Our results support the role of stress in the PRS status. It reinforces the suggested differences for clinical presentation of PRS in terms of age, highlighting the importance of gathering data on the under-18 population.
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Affiliation(s)
- Daniel Muñoz-Samons
- Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Santa Rosa, 39-57, 08950 Esplugues de Llobregat, Barcelona, Spain; Child and Adolescent Psychiatry and Psychology Department, Hospital Sant Joan de Déu of Barcelona, Passeig Sant Joan de Déu, 002, 08950 Esplugues de Llobregat, Barcelona, Spain.
| | - Jordina Tor
- Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Santa Rosa, 39-57, 08950 Esplugues de Llobregat, Barcelona, Spain; Child and Adolescent Psychiatry and Psychology Department, Hospital Sant Joan de Déu of Barcelona, Passeig Sant Joan de Déu, 002, 08950 Esplugues de Llobregat, Barcelona, Spain
| | - Marta Rodríguez-Pascual
- Child and Adolescent Psychiatry and Psychology Department, Hospital Sant Joan de Déu of Barcelona, Passeig Sant Joan de Déu, 002, 08950 Esplugues de Llobregat, Barcelona, Spain
| | - Xavier Álvarez-Subiela
- Child and Adolescent Psychiatry and Psychology Department, Hospital Sant Joan de Déu of Barcelona, Passeig Sant Joan de Déu, 002, 08950 Esplugues de Llobregat, Barcelona, Spain
| | - Gisela Sugranyes
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 28029 Madrid, Spain; Department of Child and Adolescent Psychiatry and Psychology, Hospital Clinic Universitari of Barcelona, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM (2017SGR881), Spain. Villarroel 170, 08036 Barcelona, Spain; Institut Clinic of Neurosciences, CERCA-IDIBAPS (Institut d'Investigacions Biomèdiques August Pi Sunyer), Villarroel 170, 08036 Barcelona, Spain
| | - Elena de la Serna
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 28029 Madrid, Spain; Department of Child and Adolescent Psychiatry and Psychology, Hospital Clinic Universitari of Barcelona, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM (2017SGR881), Spain. Villarroel 170, 08036 Barcelona, Spain; Institut Clinic of Neurosciences, CERCA-IDIBAPS (Institut d'Investigacions Biomèdiques August Pi Sunyer), Villarroel 170, 08036 Barcelona, Spain
| | - Olga Puig
- Department of Child and Adolescent Psychiatry and Psychology, Hospital Clinic Universitari of Barcelona, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM (2017SGR881), Spain. Villarroel 170, 08036 Barcelona, Spain
| | - Montse Dolz
- Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Santa Rosa, 39-57, 08950 Esplugues de Llobregat, Barcelona, Spain; Child and Adolescent Psychiatry and Psychology Department, Hospital Sant Joan de Déu of Barcelona, Passeig Sant Joan de Déu, 002, 08950 Esplugues de Llobregat, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 28029 Madrid, Spain
| | - Inmaculada Baeza
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 28029 Madrid, Spain; Department of Child and Adolescent Psychiatry and Psychology, Hospital Clinic Universitari of Barcelona, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM (2017SGR881), Spain. Villarroel 170, 08036 Barcelona, Spain; Institut Clinic of Neurosciences, CERCA-IDIBAPS (Institut d'Investigacions Biomèdiques August Pi Sunyer), Villarroel 170, 08036 Barcelona, Spain; Department of Psychiatry and Psychobiology, Health Sciences Division, University of Barcelona, Casanova 143, 08036 Barcelona, Spain
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11
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Schultze-Lutter F, Meisenzahl E, Michel C. [Psychotic disorders in ICD-11: the revisions]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2020; 49:453-462. [PMID: 33287579 DOI: 10.1024/1422-4917/a000777] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Psychotic disorders in ICD-11: the revisions Abstract. This article provides an overview of the main changes to the chapter "Schizophrenia or Other Primary Psychotic Disorders" (6A2) from ICD-10 to ICD-11 and compares them with the psychosis chapter of DSM-5. These changes include abandoning the classical subtypes of Schizophrenia as well as of the special significance of Schneider's first-rank symptoms, resulting in the general requirement of two key features (one must be a positive symptom) in the definition of "Schizophrenia" (6A20) and the allowance for bizarre contents in "Delusional Disorder" (6A24), which now includes "Induced Delusional Disorder" (F24). Further introduced are the focus on the current episode, the restriction of "Acute and Transient Psychotic Disorder" (6A23) to the former Polymorphic Disorder Without Schizophrenic Symptoms (F23.0), the diagnosis of delusional "Obsessive-Compulsive or Related Disorders" (6B2) exclusively as Obsessive-Compulsive Disorders, the specification of "Schizoaffective Disorder" (6A21), and the formulation of a distinct subchapter "Catatonia" (6A4) for the assessment of catatonic features in the context of several disorders. In analogy to DSM-5, ICD-11 now includes the optional category "Symptomatic Manifestations of Primary Psychotic Disorders" (6A25) for the dimensional quantification of symptoms. Again, developmental aspects remain unattended in in the ICD-11-definitions of psychotic disorders.
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Affiliation(s)
- Frauke Schultze-Lutter
- Klinik für Psychiatrie und Psychotherapie, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland.,Universitätsklinik für Kinder- und Jugendpsychiatrie und Psychotherapie, Universität Bern, Bern, Schweiz.,Department of Psychology and Mental Health, Faculty of Psychology, Airlangga University, Surabaya, Indonesia
| | - Eva Meisenzahl
- Klinik für Psychiatrie und Psychotherapie, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - Chantal Michel
- Universitätsklinik für Kinder- und Jugendpsychiatrie und Psychotherapie, Universität Bern, Bern, Schweiz
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12
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Metabolite abnormalities in psychosis risk: A meta-analysis of proton magnetic resonance spectroscopy studies. Asian J Psychiatr 2020; 54:102220. [PMID: 32653847 DOI: 10.1016/j.ajp.2020.102220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/23/2020] [Accepted: 06/10/2020] [Indexed: 12/28/2022]
Abstract
Accumulating evidence implicates that individuals at high-risk of psychosis have already exhibited pathophysiological changes in brain metabolites including glutamate, gamma-Aminobutyric Acid (GABA), N-Acetylaspartate (NAA), creatine (Cr), myo-inositol (MI) and choline (Cho). These changes may contribute to the development of schizophrenia and associate with psychotic genes. However, specific metabolic changes of brain sub-regions in individuals at risk have still been controversial. Thus, the current study aimed to investigate the brain metabolic changes including glutamate, Glx, GABA, GABA/Glx, NAA, Cr, MI and Cho levels in individuals at risk by conducting a case-control meta-analysis and meta-regression of proton magnetic resonance spectroscopy studies. Primary outcomes revealed that individuals at risk exhibited increased Cr levels at the rostral medial prefrontal cortex (rmPFC), decreased NAA and Cr levels at the thalamus, and increased MI levels at the dorsolateral prefrontal cortex. Sub-group analyses further indicated that individuals with clinical high-risk (CHR) exhibited increased Cr levels at the medial prefrontal cortex (mPFC) and decreased Glx levels at the thalamus, while individuals with genetic risk (siblings of psychiatric patients) exhibited significant increased Glx and MI levels at the mPFC. However, GABA, GABA/Glx and Cho levels showed no significant result. These findings suggest that the dysfunctional metabolites at the mPFC and the thalamus may be an essential neurobiological basis at the early stage of psychosis.
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13
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Pontillo M, Tata MC, Averna R, Gargiullo P, Guerrera S, Vicari S. Clinical profile, conversion rate, and suicidal thinking and behaviour in children and adolescents at ultra-high risk for psychosis: a theoretical perspective. RESEARCH IN PSYCHOTHERAPY (MILANO) 2020; 23:455. [PMID: 32913830 PMCID: PMC7451377 DOI: 10.4081/ripppo.2020.455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 04/08/2020] [Indexed: 02/07/2023]
Abstract
Over the past years there has been substantial growing interest in the prodromes of psychosis to identify individuals at risk for psychosis prior to their first psychotic episode. Researchers have proposed criteria to detect young adults at Ultra-High Risk (UHR) for psychosis, and these criteria have also been applied to children and adolescents, though few clinical studies have examined this population. This theoretical perspective presents some of the crucial issues in the assessment and treatment of UHR children and adolescents: the presence of a specific clinical profile (i.e., different to that of healthy controls and UHR young adults), the predictive value of UHR criteria, and the presence and clinical significance of suicidal thinking and behaviour. In UHR children and adolescents, like UHR young adults, the presence of Attenuated Psychotic Symptoms (APS) is the most frequently reported inclusion criterion at baseline, with a prevalence of approximately 89–100%. In addition, there are frequently non-psychotic comorbid diagnoses of depressive and anxiety disorders. In contrast to the UHR adult population, UHR children and adolescents demonstrate a lower conversion rate to frank psychosis, most likely due to their high rate of APS. Finally, UHR adolescents report a high prevalence of suicidal ideation and self-injurious behaviour (67.5%), as well as a significantly greater frequency of attempted suicide, relative to adolescents with frank psychosis. On this basis, UHR children and adolescents report a clinical complexity that should be carefully monitored and considered for specific and targeted therapeutic interventions to be planned and developed.
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Affiliation(s)
- Maria Pontillo
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Rome
| | - Maria Cristina Tata
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Rome
| | - Roberto Averna
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Rome
| | - Prisca Gargiullo
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Rome
| | - Silvia Guerrera
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Rome
| | - Stefano Vicari
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Rome.,Institute of Psychiatry, Fondazione Policlinico Universitario A. Gemelli, Catholic University, Rome, Italy
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14
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Walger H, Antonucci LA, Pigoni A, Upthegrove R, Salokangas RKR, Lencer R, Chisholm K, Riecher-Rössler A, Haidl T, Meisenzahl E, Rosen M, Ruhrmann S, Kambeitz J, Kambeitz-Ilankovic L, Falkai P, Ruef A, Hietala J, Pantelis C, Wood SJ, Brambilla P, Bertolino A, Borgwardt S, Koutsouleris N, Schultze-Lutter F. Basic Symptoms Are Associated With Age in Patients With a Clinical High-Risk State for Psychosis: Results From the PRONIA Study. Front Psychiatry 2020; 11:552175. [PMID: 33312133 PMCID: PMC7707000 DOI: 10.3389/fpsyt.2020.552175] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 10/22/2020] [Indexed: 12/16/2022] Open
Abstract
In community studies, both attenuated psychotic symptoms (APS) and basic symptoms (BS) were more frequent but less clinically relevant in children and adolescents compared to adults. In doing so, they displayed differential age thresholds that were around age 16 for APS, around age 18 for perceptive BS, and within the early twenties for cognitive BS. Only the age effect has previously been studied and replicated in clinical samples for APS. Thus, we examined the reported age effect on and age thresholds of 14 criteria-relevant BS in a patient sample at clinical-high risk of psychosis (N = 261, age 15-40 yrs.), recruited within the European multicenter PRONIA-study. BS and the BS criteria, "Cognitive Disturbances" (COGDIS) and "Cognitive-perceptive BS" (COPER), were assessed with the "Schizophrenia Proneness Instrument, Adult version" (SPI-A). Using logistic regressions, prevalence rates of perceptive and cognitive BS, and of COGDIS and COPER, as well as the impact of social and role functioning on the association between age and BS were studied in three age groups (15-18 years, 19-23 years, 24-40 years). Most patients (91.2%) reported any BS, 55.9% any perceptive and 87.4% any cognitive BS. Furthermore, 56.3% met COGDIS and 80.5% COPER. Not exhibiting the reported differential age thresholds, both perceptive and cognitive BS, and, at trend level only, COPER were less prevalent in the oldest age group (24-40 years); COGDIS was most frequent in the youngest group (15-18 years). Functional deficits did not better explain the association with age, particularly in perceptive BS and cognitive BS meeting the frequency requirement of BS criteria. Our findings broadly confirmed an age threshold in BS and, thus, the earlier assumed link between presence of BS and brain maturation processes. Yet, age thresholds of perceptive and cognitive BS did not differ. This lack of differential age thresholds might be due to more pronounced the brain abnormalities in this clinical sample compared to earlier community samples. These might have also shown in more frequently occurring and persistent BS that, however, also resulted from a sampling toward these, i.e., toward COGDIS. Future studies should address the neurobiological basis of CHR criteria in relation to age.
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Affiliation(s)
- Helene Walger
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Linda A Antonucci
- Department of Education, Psychology, Communication, University of Bari Aldo Moro, Bari, Italy
| | - Alessandro Pigoni
- Department of Neurosciences and Mental Health, Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Foundation Major Hospital Polyclinic, University of Milan, Milan, Italy.,MoMiLab Research Unit, Institutions, Markets, Technologies (IMT) School for Advanced Studies Lucca, Lucca, Italy
| | - Rachel Upthegrove
- Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom
| | | | - Rebekka Lencer
- Department of Psychiatry and Psychotherapy, and Otto Creutzfeldt Center for Cognitive and Behavioral Neuroscience, University of Muenster, Muenster, Germany
| | - Katharine Chisholm
- Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom.,Department of Psychology, Aston University, Birmingham, United Kingdom
| | - Anita Riecher-Rössler
- Department of Psychiatry (Psychiatric University Hospital, UPK), University of Basel, Basel, Switzerland
| | - Theresa Haidl
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Eva Meisenzahl
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Marlene Rosen
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Joseph Kambeitz
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Lana Kambeitz-Ilankovic
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Anne Ruef
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Jarmo Hietala
- Department of Psychiatry, Medical Faculty, University of Turku, Turku, Finland
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, Carlton, VIC, Australia
| | - Stephen J Wood
- Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom.,Orygen, The National Centre of Excellence for Youth Mental Health, Melbourne, VIC, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Foundation Major Hospital Polyclinic, University of Milan, Milan, Italy
| | - Alessandro Bertolino
- Group of Psychiatric Neuroscience, Department of Basic Medical Science, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Stefan Borgwardt
- Department of Psychiatry (Psychiatric University Hospital, UPK), University of Basel, Basel, Switzerland
| | - Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Frauke Schultze-Lutter
- Department of Education, Psychology, Communication, University of Bari Aldo Moro, Bari, Italy.,Department of Psychology and Mental Health, Faculty of Psychology, Airlangga University, Surabaya, Indonesia
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15
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Schultze-Lutter F, Ruhrmann S, Michel C, Kindler J, Schimmelmann BG, Schmidt SJ. Age effects on basic symptoms in the community: A route to gain new insight into the neurodevelopment of psychosis? Eur Arch Psychiatry Clin Neurosci 2020; 270:311-324. [PMID: 30361925 PMCID: PMC7069926 DOI: 10.1007/s00406-018-0949-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 10/19/2018] [Indexed: 02/06/2023]
Abstract
Reports of limited clinical significance of attenuated psychotic symptoms before age 15/16 indicate an important role of neurodevelopment in the early detection of psychoses. Therefore, we examined if age also exerts an influence on the prevalence and clinical significance of the 14 cognitive and perceptive basic symptoms (BS) used in psychosis-risk criteria and conceptualized as the most direct self-experienced expression of neurobiological aberrations. A random representative general population sample of the Swiss canton Bern (N = 689, age 8-40 years, 06/2011-05/2014) was interviewed for BS, psychosocial functioning, and current mental disorder. BS were reported by 18% of participants, mainly cognitive BS (15%). In regression analyses, age affected perceptive and cognitive BS differently, indicating an age threshold for perceptive BS in late adolescence (around age 18) and for cognitive BS in young adulthood (early twenties)-with higher prevalence, but a lesser association with functional deficits and the presence of mental disorder in the below-threshold groups. Thereby, interaction effects between age and BS on functioning and mental disorder were commonly stronger than individual effects of age and BS. Indicating support of the proposed "substrate-closeness" of BS, differential age effects of perceptual and cognitive BS seem to follow normal brain maturation processes, in which they might occur as infrequent and temporary non-pathological disturbances. Their persistence or occurrence after conclusion of main brain maturation processes, however, might signify aberrant maturation or neurodegenerative processes. Thus, BS might provide important insight into the pathogenesis of psychosis and into differential neuroprotective or anti-inflammatory targets.
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Affiliation(s)
- Frauke Schultze-Lutter
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland. .,Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Bergische Landstrasse 2, 40629, Düsseldorf, Germany.
| | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - Chantal Michel
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Jochen Kindler
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Benno G. Schimmelmann
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland ,University Hospital of Child and Adolescent Psychiatry, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Stefanie J. Schmidt
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland ,Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany ,Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
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16
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Poletti M, Pelizza L, Azzali S, Paterlini F, Garlassi S, Scazza I, Chiri LR, Gebhardt E, Pupo S, Andrea R. Clinical high risk for psychosis in childhood and adolescence: findings from the 2-year follow-up of the ReARMS project. Eur Child Adolesc Psychiatry 2019; 28:957-971. [PMID: 30506419 DOI: 10.1007/s00787-018-1262-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Accepted: 11/29/2018] [Indexed: 12/25/2022]
Abstract
The clinical significance and the prognostic value of clinical high risk (CHR) for psychosis, while substantially corroborated in adults, remains less firmly established in children and early adolescents. This follow-up study, developed within the Reggio Emilia At Risk Mental States project, is meant to contribute to the reduction of such lacuna, and has two main aims: (1) to characterize the clinical profile of help seekers [stratified in non-CHR, CHR and first episode psychosis (FEP)] referred to child-adolescent mental health services; and (2) to monitor the cumulative transition rate from CHR to FEP in adolescents at the follow-up of 12 and 24 months. 112 adolescents (aged 13-18 years) were assessed with the Comprehensive Assessment of At-Risk Mental States and the Schizophrenia Proneness Instrument, Child and Youth version. 51 subjects met CHR criteria (45.5% of the sample) and 33 subjects met FEP criteria (29.5%) at baseline. The criterial transition rate from CHR to FEP was 7% over 12 months and 13% over 24 months; higher rates of cumulative transition were detected when also functional transition (indexed by the consensual introduction of antipsychotic medication by the treating clinical staff) was considered. The identification of CHR for psychosis in help-seeking adolescents is feasible and clinically relevant. Studies conducted in real world, publicly funded components of the national health system, should take into consideration not only criterial, psychometric transition, but also functional equivalents of transition.
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Affiliation(s)
- Michele Poletti
- Department of Mental Health and Pathological Addiction, AUSL-IRCSS di Reggio Emilia, Via Amendola n.2, 42100, Reggio Emilia (RE), Italy
| | - Lorenzo Pelizza
- Department of Mental Health and Pathological Addiction, AUSL-IRCSS di Reggio Emilia, Via Amendola n.2, 42100, Reggio Emilia (RE), Italy.
| | - Silvia Azzali
- Department of Mental Health and Pathological Addiction, AUSL-IRCSS di Reggio Emilia, Via Amendola n.2, 42100, Reggio Emilia (RE), Italy
| | - Federica Paterlini
- Department of Mental Health and Pathological Addiction, AUSL-IRCSS di Reggio Emilia, Via Amendola n.2, 42100, Reggio Emilia (RE), Italy
| | - Sara Garlassi
- Department of Mental Health and Pathological Addiction, AUSL-IRCSS di Reggio Emilia, Via Amendola n.2, 42100, Reggio Emilia (RE), Italy
| | - Ilaria Scazza
- Department of Mental Health and Pathological Addiction, AUSL-IRCSS di Reggio Emilia, Via Amendola n.2, 42100, Reggio Emilia (RE), Italy
| | - Luigi Rocco Chiri
- Department of Mental Health and Pathological Addiction, AUSL di Bologna, Bologna, Italy
| | - Eva Gebhardt
- Cmed Polyspecialistic Diagnostic and Therapeutic Centre, Rome, Italy
| | - Simona Pupo
- Intensive Care Unit, Anesthesia and Resuscitation Service, Guastalla Civil Hospital, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Raballo Andrea
- Department of Psychology, Childhood and Development Research Group, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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17
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Donfrancesco R, Vezzani C, Pinto G, Bigozzi L, Dibenedetto A, Melegari MG, Gregori P, Andriola E, Di Roma F, Renzi A, Tambelli R, Di Trani M. The Validation of the Free Fantasy Questionnaire for Children and Adolescents: From Imaginary Playmate to "Dreamtime". Front Psychol 2019; 10:1343. [PMID: 31231290 PMCID: PMC6567922 DOI: 10.3389/fpsyg.2019.01343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 05/23/2019] [Indexed: 11/13/2022] Open
Abstract
Fantasy in children is a precocious and important skill. In normal subjects some imaginative events, very close to hallucinations (perception-like experiences), have been found. Therefore, a better knowledge on both fantasy and the difference between imagination and the external world is needed. The aims of this study are: (a) to validate a new questionnaire for fantasy in children and adolescents; (b) to test its clinical application in ADHD children. 1.707 participants aged 8-18 years were enrolled: 1557 were recruited from a survey in six schools, whereas 150 participants were recruited in an ADHD Center. They filled out a new questionnaire, the Free Fantasy Questionnaire for Children and Adolescents, FFQ. Statistical analyses were performed to validate the FFQ and to study five parameters of fantasy. Analyses showed good properties of the FFQ as regards factor structure and reliability. Descriptive analysis showed that: 10% of the adolescents frequently have fantasy with paracosmos and 9.5% sometimes have a fantasy with imaginary relatives. Moreover, in the 64.3% of participants of primary school, in the 34.5% of lower-secondary, and in the 27.4% of upper-secondary school Perception-like experiences, involving invisible but real personages, were found. Quality of fantasy and Lack of control on imagination are correlated with a high score in the Reality/Unreality Dimension and Perception-like experiences. As regards ADHD participants, the 40% of the group showed Perception-like experiences: the 21.66% of them reported a very high score in the dimension Reality/Unreality, have some dissociative symptoms, and the 3.33% presented a clear dissociative identity disorder. All were free from psychosis or neurologic disorders. A new questionnaire to study fantasy in children and adolescents was validated. Many children and adolescents of the general population declared Perception-like experiences. These events seem to be specific, and probably normal, features of the mind; they could be better named as "Dreamtime," whereas only in extreme conditions they could represent a risk for dissociation.
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Affiliation(s)
| | - Claudio Vezzani
- Departments of Languages, Literatures and Intercultural Studies and Education and Psychology, University of Florence, Florence, Italy
| | - Giuliana Pinto
- Departments of Languages, Literatures and Intercultural Studies and Education and Psychology, University of Florence, Florence, Italy
| | - Lucia Bigozzi
- Departments of Languages, Literatures and Intercultural Studies and Education and Psychology, University of Florence, Florence, Italy
| | | | - Maria Grazia Melegari
- Department of Developmental and Social Psychology, Sapienza University of Rome, Rome, Italy
| | - Paola Gregori
- National Health System, “La Scarpetta” Center, Rome, Italy
| | - Elda Andriola
- Department of Human Science, LUMSA University, Rome, Italy
| | | | - Alessia Renzi
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Italy
| | - Renata Tambelli
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Italy
| | - Michela Di Trani
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Italy
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18
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Andreou C, Bailey B, Borgwardt S. Assessment and treatment of individuals at high risk for psychosis. BJPSYCH ADVANCES 2019. [DOI: 10.1192/bja.2019.3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SUMMARYEarly detection and specialised early intervention for people at high risk for psychotic disorders have received growing attention in the past few decades, with the aim of delaying or preventing the outbreak of explicit psychotic symptoms and improving functional outcomes. This article summarises criteria for a diagnosis of high psychosis risk, the implications for such a diagnosis and recommendations for treatment.LEARNING OBJECTIVESAfter reading this article you will be able to:
•recognise signs and symptoms indicating increased psychosis risk•understand uses and limitations of screening for high psychosis risk, and interpretation of results•recognise evidence-based treatment options for patients at clinical high risk for psychosis.DECLARATION OF INTERESTC.A. has received non-financial support from Sunovion and Lundbeck in the past 36 months.
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19
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Molteni S, Filosi E, Mensi MM, Spada G, Zandrini C, Ferro F, Paoletti M, Pichiecchio A, Bonoldi I, Balottin U. Predictors of Outcomes in Adolescents With Clinical High Risk for Psychosis, Other Psychiatric Symptoms, and Psychosis: A Longitudinal Protocol Study. Front Psychiatry 2019; 10:787. [PMID: 31849719 PMCID: PMC6902080 DOI: 10.3389/fpsyt.2019.00787] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 10/02/2019] [Indexed: 02/01/2023] Open
Abstract
In children and adolescents, schizophrenia is one of the ten main causes of disability-adjusted life years. The identification of people at Clinical High Risk of developing Psychosis (CHR-P) is one of the most promising strategies to improve outcomes. However, in children and adolescents research on the CHR-P state is still in its infancy and the clinical validity of at-risk criteria appears understudied in this population. Furthermore, only few studies have evaluated the psychopathological, neuropsychological, neuroimaging characteristics and, especially, long-term outcomes of adolescents at high risk. We present here the protocol of an innovative longitudinal cohort study of adolescents aged 12-17. The sample will consist of patients admitted to a third level neuropsychiatric unit, belonging to one of the following three subgroups: 1) adolescents with established Diagnostic and Statistical Manual of Mental Disorder-Fifth Edition psychosis, 2) adolescents with CHR-P, and 3) adolescents with psychiatric symptoms other than established psychosis or CHR-P. The primary aim of our study is to evaluate the 2-year prognosis across the three groups. We will measure transition to psychosis (or the stability of the diagnosis of psychosis in the psychotic group), the risk of development of other psychiatric disorders, as well as socio-occupational functioning at outcome. The secondary aim will be to explore the effect of specific predictors (clinical, neuropsychological and neuroimaging factors) on the prognosis. At baseline, 1-year and 2-year follow-up participants will be assessed using standardized semi-structured interviews and instruments. Psychopathological and functioning variables, as well as neuropsychological domains will be compared across the three subgroups. Moreover, at baseline and 2-year follow-up all recruited patients will undergo a 3-Tesla magnetic resonance imaging examination and diffusion tensor imaging parameters will be analyzed. We believe that this study will advance our ability to predict outcomes in underage CHR-P samples. In particular, our data will enable a better understanding of the clinical significance of CHR-P in adolescents, and shed new light on prognostic factors that can be used to refine the prediction of clinical outcomes and the implementation of preventive interventions.
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Affiliation(s)
- Silvia Molteni
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Eleonora Filosi
- Child Neuropsychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Maria Martina Mensi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Child Neuropsychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Giulia Spada
- Institute of Psychiatry, Psychology and Neuroscience, King's College of London, London, United Kingdom
| | - Chiara Zandrini
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Federica Ferro
- Child Neuropsychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Matteo Paoletti
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Neuroradiology Department, IRCCS Mondino Foundation, Pavia, Italy
| | - Anna Pichiecchio
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Neuroradiology Department, IRCCS Mondino Foundation, Pavia, Italy
| | - Ilaria Bonoldi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Institute of Psychiatry, Psychology and Neuroscience, King's College of London, London, United Kingdom
| | - Umberto Balottin
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Child Neuropsychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
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20
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Bang KS, Kim S, Kang K, Song M. Physical Symptoms, Depression, and Related Factors of Late School-age Children in Seoul, Korea: The Mediating Role of Peer Relationships. J Pediatr Nurs 2018; 43:e120-e125. [PMID: 30269867 DOI: 10.1016/j.pedn.2018.09.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 09/18/2018] [Accepted: 09/18/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Recent studies have highlighted the importance of peer relationships on the physical and mental health of late school-age children. However, little is known about the causal relationships whereby peer relationships affect health problems. This study aimed to examine the specific associations between physical symptoms and depression and their influential factors, including the quality of peer relationships. Additionally, the causal relationships were examined, focusing on the mediating role of the quality of peer relationships. DESIGN AND METHODS A cross-sectional study design was employed with 302 elementary students in grades four and five. Perceived socioeconomic status, the quality of peer relationships, family functioning, physical symptoms, and depression symptoms were measured with self-report questionnaires. Data were analyzed with descriptive statistics, t-tests, ANOVA, Pearson's correlations, and multiple regression. RESULTS The number of reported physical symptoms had a significant negative correlation with peer relationships (r = -0.517, p < 0.001) and family functioning (r = -0.279, p < 0.001). Depression was significantly negatively correlated with the quality of peer relationships (r = -0.775, p < 0.001) and family functioning (r = -0.428, p < 0.001). Peer relationships mediated the link between family functioning and physical symptoms. Peer relationships also mediated the relationship between family functioning and depression. CONCLUSIONS Peer relationships significantly influenced the physical and mental health of late school-age children in Korea. PRACTICE IMPLICATIONS Nursing intervention programs for improving peer relationships among children may be necessary to achieve their optimal health status.
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Affiliation(s)
- Kyung-Sook Bang
- College of Nursing, The Research Institute of Nursing Science, Seoul National University, Seoul, Republic of Korea
| | - Sungjae Kim
- College of Nursing, The Research Institute of Nursing Science, Seoul National University, Seoul, Republic of Korea
| | - Kyungim Kang
- College of Nursing, Seoul National University, Jongno-gu, Seoul, Republic of Korea.
| | - Minkyung Song
- College of Nursing, Seoul National University, Jongno-gu, Seoul, Republic of Korea
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21
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de Jong Y, Mulder CL, Boon AE, Deen M, van 't Hof M, van der Gaag M. Screening for psychosis risk among adolescents in Child and Adolescent Mental Health Services: a description of the first step with the 16-item version of the Prodromal Questionnaire (PQ-16). Early Interv Psychiatry 2018; 12:669-676. [PMID: 27860294 DOI: 10.1111/eip.12362] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 05/15/2016] [Accepted: 06/12/2016] [Indexed: 01/03/2023]
Abstract
AIM Although the 16-item version of the Prodromal Questionnaire (PQ-16) is used as a screener in the early detection of psychosis risk, little is known about PQ-16 scores among adolescents referred to the Child and Adolescent Mental Health Services. We assessed such scores in adolescents referred to these services in the Netherlands, and also their associations with age, gender, diagnosis and level of functioning. METHODS The PQ-16 was added to regular intake procedures. RESULTS The PQ-16 was completed by 176 adolescents (mean age 14.58 years; standard deviation = 1.50; 55.1% females), 34.7% of whom scored above the current cut-off score of ≥6 items. Positive item scores with the highest odds ratio for scoring above the cut-off were related to tasting or smelling things, seeing things and hearing thoughts out aloud. There were no age-, gender- or disorder-related differences in total scores on the PQ-16. Lower Global Assessment of Functioning scores were associated with higher total scores on the PQ-16. CONCLUSIONS The PQ-16 is easy to implement in routine assessment and can be useful to bring up potential psychotic symptoms for further exploration in an early stage, especially in adolescents with low Global Assessment of Functioning scores. The PQ-16 total scores were not confounded by differences in age, gender or disorder. Future research should investigate the true nature of PQ-16 items and whether the item scores and cut-off scores of the PQ-16 in adolescence have any predictive value regarding the development of an ultra high-risk status, a psychotic disorder or other mental disorders.
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Affiliation(s)
- Yvonne de Jong
- Lucertis Center for Child and Adolescence Psychiatry, Rotterdam, The Netherlands.,Department of Psychiatry, Epidemiological and Psychiatric Research institute, Rotterdam, The Netherlands
| | - Cornelis L Mulder
- Department of Psychiatry, Epidemiological and Psychiatric Research institute, Rotterdam, The Netherlands.,Parnassia Psychiatric Institute, Rotterdam, The Netherlands
| | - Albert E Boon
- Department of Child and Adolescent Psychiatry, Curium-Leiden University Medical Center, Oegstgeest, The Netherlands.,Lucertis Center for Child and Adolescence Psychiatry, Capelle a/d IJssel, The Netherlands
| | - Mathijs Deen
- Scientific research department, Parnassia Academy, The Hague, The Netherlands.,Faculty of Social and Behavioural Sciences, Leiden University, Leiden, The Netherlands
| | - Maarten van 't Hof
- Lucertis Center for Child and Adolescence Psychiatry, Rotterdam, The Netherlands
| | - Mark van der Gaag
- VU University and, EMGO Mental Health and Care Research, Dept. of Clinical Psychology, Amsterdam, The Netherlands.,Parnassia Psychiatric Institute, Zoutkeetsingel, The Hague, The Netherlands
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22
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Clinical high risk for psychosis in children and adolescents: a systematic review. Eur Child Adolesc Psychiatry 2018; 27:683-700. [PMID: 28914382 DOI: 10.1007/s00787-017-1046-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 08/31/2017] [Indexed: 12/31/2022]
Abstract
The concept of being at risk for psychosis has been introduced both for adults and children and adolescents, but fewer studies have been conducted in the latter population. The aim of this study is to systematically review the articles associated with clinical description, interventions, outcome and other areas in children and adolescents at risk for psychosis. We searched in MEDLINE/PubMed and PsycINFO databases for articles published up to 30/06/16. Reviewed articles were prospective studies; written in English; original articles with Clinical High Risk (CHR) for psychosis samples; and mean age of samples younger than 18 years. From 103 studies initially selected, 48 met inclusion criteria and were systematically reviewed. Studies show that CHR children and adolescents present several clinical characteristics at baseline, with most attenuated positive-symptom inclusion criteria observed, reporting mostly perceptual abnormalities and suspiciousness, and presenting comorbid conditions such as depressive and anxiety disorders. CHR children and adolescents show lower general intelligence and no structural brain changes compared with controls. Original articles reviewed show rates of conversion to psychosis between 17 and 20% at 1 year follow-up and between 7 and 21% at 2 years. While 36% of patients recovered from their CHR status at 6-year follow-up, 40% still met CHR criteria. Studies in children and adolescents with CHR were conducted with different methodologies, assessments tools and small samples. It is important to conduct studies on psychopharmacological and psychological treatment, as well as replication of the few studies found.
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23
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Pelizza L, Azzali S, Garlassi S, Paterlini F, Scazza I, Chiri LR, Pupo S, Raballo A. Adolescents at ultra-high risk of psychosis in Italian neuropsychiatry services: prevalence, psychopathology and transition rate. Eur Child Adolesc Psychiatry 2018; 27:725-737. [PMID: 29058115 DOI: 10.1007/s00787-017-1070-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 10/16/2017] [Indexed: 11/26/2022]
Abstract
Studies in adolescents on ultra-high risk (UHR) and basic symptoms (BS) criteria for psychosis prediction are scarce. In Italy, early interventions in psychosis are less widespread than in other European countries. In the present study, we (1) assessed the clinical relevance of a UHR diagnosis [according to the comprehensive assessment of at-risk mental states (CAARMS) criteria] to promote the implementation of specific services for UHR adolescents into the Italian health care system; (2) described severity of positive, negative, general, and basic symptoms in UHR adolescents compared to adolescents with first-episode psychosis (FEP) and non-UHR adolescents (i.e., individuals who did not meet CAARMS criteria for UHR or FEP); and (3) investigated the predictive validity of UHR criteria in relation to BS criteria. Seventy-nine adolescents (aged 13-18 years) were assessed with the CAARMS, the positive and negative syndrome scale (PANSS), and the schizophrenia proneness instrument, child and youth version (SPI-CY). Both UHR (n = 25) and FEP (n = 11) had significantly higher PANSS subscale scores compared to non-UHR (n = 43). UHR had significantly lower PANSS-positive symptom scores than FEP, but similar global functioning and PANSS-negative symptoms and general psychopathology scores. Compared to non-UHR, both FEP and UHR had more severe thought and perception BS disturbances, and significantly more often met BS criteria. After 12 months, 2 of 20 (10%) UHR had transitioned to psychosis. They also met both BS criteria. Given the uncertain outcome of UHR adolescents, future research is needed to determine whether the combined assessment of BS with UHR symptoms can improve the accuracy of psychosis prediction in adolescence.
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Affiliation(s)
- Lorenzo Pelizza
- Department of Mental Health and Addiction, Reggio Emilia Public Health Care Centre, c/o CSM Petrella, Via Petrella n.1/A, 42100, Reggio Emilia, RE, Italy.
| | - Silvia Azzali
- Department of Mental Health and Addiction, Reggio Emilia Public Health Care Centre, c/o CSM Petrella, Via Petrella n.1/A, 42100, Reggio Emilia, RE, Italy
| | - Sara Garlassi
- Department of Mental Health and Addiction, Reggio Emilia Public Health Care Centre, c/o CSM Petrella, Via Petrella n.1/A, 42100, Reggio Emilia, RE, Italy
| | - Federica Paterlini
- Department of Mental Health and Addiction, Reggio Emilia Public Health Care Centre, c/o CSM Petrella, Via Petrella n.1/A, 42100, Reggio Emilia, RE, Italy
| | - Ilaria Scazza
- Department of Mental Health and Addiction, Reggio Emilia Public Health Care Centre, c/o CSM Petrella, Via Petrella n.1/A, 42100, Reggio Emilia, RE, Italy
| | - Luigi Rocco Chiri
- Department of Mental Health and Addiction, Bologna Public Health Care Centre, Bologna, Italy
| | - Simona Pupo
- Reggio Emilia Public Health Care Centre, Guastalla Civil Hospital, Guastalla, RE, Italy
| | - Andrea Raballo
- Department of Mental Health and Addiction, Reggio Emilia Public Health Care Centre, c/o CSM Petrella, Via Petrella n.1/A, 42100, Reggio Emilia, RE, Italy
- Department of Psychology and Development, Norwegian University of Science and Technology, Trondheim, Norway
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24
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Omel'chenko MA, Rumyantsev AO, Kaleda VG. [The dynamics of psychopathological symptoms of ultra high risk for psychosis in young patients with non-psychotic mental disorders]. Zh Nevrol Psikhiatr Im S S Korsakova 2018; 116:16-21. [PMID: 27029442 DOI: 10.17116/jnevro20161162116-21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Based on the results of 5-year follow-up study, to describe the dynamics of psychopathological symptoms in young patients with non-psychotic forms of mental diseases met the criteria of ultra-high risk for schizophrenia who received preventive psychopharmacotherapy. MATERIAL AND METHODS The study included 32 young men, aged 16--25 years, presented with the symptoms of ultra-high risk of schizophrenia during the first hospitalization in 2009--2011. Follow-up was carried out in 2014--2015 (mean follow-up 5.79±0.36 years). According to ICD-10, patients were stratified into 3 groups: mood disorders, personality disorders and schizotypal disorders. RESULTS AND CONCLUSION According to the characteristics of subsequent development of these disorders, four types were singled out: mechanisms of the development of acute sensitive delusions (I), interpretative delusions (II), catatonic disorganization (III) and cognitive disorders pathognomonic for schizophrenia spectrum disorders (IV). Correlations between these types and nosologic disorders and their different reversibility under treatment were found. These types can be considered as predictors of outcome over the follow-up period.
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25
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MacKenzie LE, Patterson VC, Zwicker A, Drobinin V, Fisher HL, Abidi S, Greve AN, Bagnell A, Propper L, Alda M, Pavlova B, Uher R. Hot and cold executive functions in youth with psychotic symptoms. Psychol Med 2017; 47:2844-2853. [PMID: 28587688 DOI: 10.1017/s0033291717001374] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Psychotic symptoms are common in children and adolescents and may be early manifestations of liability to severe mental illness (SMI), including schizophrenia. SMI and psychotic symptoms are associated with impairment in executive functions. However, previous studies have not differentiated between 'cold' and 'hot' executive functions. We hypothesized that the propensity for psychotic symptoms is specifically associated with impairment in 'hot' executive functions, such as decision-making in the context of uncertain rewards and losses. METHODS In a cohort of 156 youth (mean age 12.5, range 7-24 years) enriched for familial risk of SMI, we measured cold and hot executive functions with the spatial working memory (SWM) task (total errors) and the Cambridge Gambling Task (decision-making), respectively. We assessed psychotic symptoms using the semi-structured Kiddie Schedule for Affective Disorders and Schizophrenia interview, Structured Interview for Prodromal Syndromes, Funny Feelings, and Schizophrenia Proneness Instrument - Child and Youth version. RESULTS In total 69 (44.23%) youth reported psychotic symptoms on one or more assessments. Cold executive functioning, indexed with SWM errors, was not significantly related to psychotic symptoms [odds ratio (OR) 1.36, 95% confidence interval (CI) 0.85-2.17, p = 0.204). Poor hot executive functioning, indexed as decision-making score, was associated with psychotic symptoms after adjustment for age, sex and familial clustering (OR 2.37, 95% CI 1.25-4.50, p = 0.008). The association between worse hot executive functions and psychotic symptoms remained significant in sensitivity analyses controlling for general cognitive ability and cold executive functions. CONCLUSIONS Impaired hot executive functions may be an indicator of risk and a target for pre-emptive early interventions in youth.
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Affiliation(s)
- L E MacKenzie
- Department of Psychology and Neuroscience,Dalhousie University,Halifax, Nova Scotia,Canada
| | - V C Patterson
- Department of Psychiatry,Dalhousie University,Halifax, Nova Scotia,Canada
| | - A Zwicker
- Department of Psychiatry,Dalhousie University,Halifax, Nova Scotia,Canada
| | - V Drobinin
- Department of Psychiatry,Dalhousie University,Halifax, Nova Scotia,Canada
| | - H L Fisher
- Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London,UK
| | - S Abidi
- Department of Psychiatry,Dalhousie University,Halifax, Nova Scotia,Canada
| | - A N Greve
- Psychosis Research Unit,Aarhus University Hospital,Risskov,Denmark
| | - A Bagnell
- Department of Psychiatry,Dalhousie University,Halifax, Nova Scotia,Canada
| | - L Propper
- Department of Psychiatry,Dalhousie University,Halifax, Nova Scotia,Canada
| | - M Alda
- Department of Psychiatry,Dalhousie University,Halifax, Nova Scotia,Canada
| | - B Pavlova
- Department of Psychiatry,Dalhousie University,Halifax, Nova Scotia,Canada
| | - R Uher
- Department of Psychology and Neuroscience,Dalhousie University,Halifax, Nova Scotia,Canada
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The Italian version of the 92-item Prodromal Questionnaire: Concurrent validity with the SIPS and factor analysis in a sample of 258 outpatients aged 11-36years. Schizophr Res 2017; 189:50-56. [PMID: 28254200 DOI: 10.1016/j.schres.2017.02.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 02/06/2017] [Accepted: 02/07/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND Current early screeners for psychosis-risk states have still to prove ability in identifying at-risk individuals. Among screeners, the 92-item Prodromal Questionnaire (PQ-92) is often used. We aimed to assess the validity of its Italian translation in a large Italian adolescent and young adult help-seeking sample. METHODS We included all individuals aged 12-36years seeking help at psychiatric mental health services in a large semirural Roman area (534,600 population) who accepted to participate. Participants completed the Italian version of the PQ-92 and were subsequently assessed with the Structured Interview of Prodromal/Psychosis-Risk Syndromes (SIPS). We examined diagnostic accuracy (sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios) and content, concurrent, and convergent validity between PQ-92 and SIPS using Cronbach's alpha, Cohen's kappa, and Spearman's rho, respectively. We tested the validity of adopted cut-offs through Receiver Operating Characteristic (ROC) curves plotted against SIPS diagnoses and the instrument's factor-structure through Principal Component Analysis. RESULTS PQ-92 showed high internal consistency, acceptable diagnostic accuracy and concurrent validity, and excellent convergent validity. ROC analyses pointed to scores of 18 on the Positive subscale and 36 on the total PQ-92 as best cut-offs. The Scree-test identified a four-factor solution as fitting best. CONCLUSIONS Psychometric properties of Italian PQ-92 were satisfactory. Optimal cut-offs were confirmed at ≥18 on the positive subscale, but at ≥36 on the total scale was able to identify more SIPS-positive cases.
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Ribolsi M, Lin A, Wardenaar KJ, Pontillo M, Mazzone L, Vicari S, Armando M. Clinical presentation of Attenuated Psychosis Syndrome in children and adolescents: Is there an age effect? Psychiatry Res 2017; 252:169-174. [PMID: 28282534 DOI: 10.1016/j.psychres.2017.02.050] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 01/04/2017] [Accepted: 02/15/2017] [Indexed: 01/11/2023]
Abstract
There is limited research on clinical features related to age of presentation of the Attenuated Psychosis Syndrome in children and adolescents (CAD). Based on findings in CAD with psychosis, we hypothesized that an older age at presentation of Attenuated Psychosis Syndrome would be associated with less severe symptoms and better psychosocial functioning than presentation in childhood or younger adolescence. Ninety-four CAD (age 9-18) meeting Attenuated Psychosis Syndrome criteria participated in the study. The sample was divided and compared according to the age of presentation of Attenuated Psychosis Syndrome (9-14 vs 15-18 years). The predictive value of age of Attenuated Psychosis Syndrome presentation was investigated using receiver operating characteristic (ROC)-curve calculations. The two Attenuated Psychosis Syndrome groups were homogeneous in terms of gender distribution, IQ scores and comorbid diagnoses. Older Attenuated Psychosis Syndrome patients showed better functioning and lower depressive scores. ROC curves revealed that severity of functional impairment was best predicted using an age of presentation cut-off of 14.9 years for social functioning and 15.9 years for role functioning. This study partially confirmed our hypothesis; older age at presentation of Attenuated Psychosis Syndrome was associated with less functional impairment, but age was not associated with psychotic symptoms.
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Affiliation(s)
- Michele Ribolsi
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Piazza Sant'Onofrio 4, 00165 Rome, Italy
| | - Ashleigh Lin
- Telethon Kids Institute, The University of Western Australia, 100 Roberts Road, Subiaco, 6008 Western Australia, Australia
| | - Klaas J Wardenaar
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, The Netherlands
| | - Maria Pontillo
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Piazza Sant'Onofrio 4, 00165 Rome, Italy
| | - Luigi Mazzone
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Piazza Sant'Onofrio 4, 00165 Rome, Italy
| | - Stefano Vicari
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Piazza Sant'Onofrio 4, 00165 Rome, Italy
| | - Marco Armando
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Piazza Sant'Onofrio 4, 00165 Rome, Italy; Developmental Imaging and Psychopathology Laboratory, University of Geneva School of Medicine, Geneva, Switzerland.
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Entwicklungsspezifische Aspekte in der Früherkennung und Frühbehandlung eines erhöhten Psychoserisikos. Prax Kinderpsychol Kinderpsychiatr 2017; 66:324-344. [DOI: 10.13109/prkk.2017.66.5.324] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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29
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Lo Cascio N, Saba R, Hauser M, Vernal DL, Al-Jadiri A, Borenstein Y, Sheridan EM, Kishimoto T, Armando M, Vicari S, Fiori Nastro P, Girardi P, Gebhardt E, Kane JM, Auther A, Carrión RE, Cornblatt BA, Schimmelmann BG, Schultze-Lutter F, Correll CU. Attenuated psychotic and basic symptom characteristics in adolescents with ultra-high risk criteria for psychosis, other non-psychotic psychiatric disorders and early-onset psychosis. Eur Child Adolesc Psychiatry 2016; 25:1091-102. [PMID: 26921232 DOI: 10.1007/s00787-016-0832-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 02/11/2016] [Indexed: 10/22/2022]
Abstract
While attenuated psychotic symptoms (APS) and basic symptoms (BS) are the main current predictors of psychosis in adults, studies in adolescents are scarce. Thus, we (1) described the prevalence and severity of positive, negative, disorganization, general, and basic symptoms in adolescent patients at ultra-high risk for psychosis (UHR), with other non-psychotic psychiatric disorders (PC) and with early-onset psychosis (EOP); and (2) investigated BS criteria in relation to UHR criteria. Sixty-nine 12-18-year-old adolescents (15.3 ± 1.7 years, female = 58.0 %, UHR = 22, PC = 27, EOP = 20) were assessed with the structured interview for prodromal syndromes (SIPS) and the schizophrenia proneness instrument-child and youth version (SPI-CY). Despite similar current and past 12-month global functioning, both UHR and EOP had significantly higher SIPS total and subscale scores compared to PC, with moderate-large effect sizes. Expectedly, UHR had significantly lower SIPS positive symptom scores than EOP, but similar SIPS negative, disorganized, and general symptom scores. Compared to PC, both EOP and UHR had more severe basic thought and perception disturbances, and significantly more often met cognitive disturbances criteria (EOP = 50.0 %, UHR = 40.9 %, PC = 14.8 %). Compared to UHR, both EOP and PC significantly less often met cognitive-perceptive BS criteria (EOP = 35.0 %, UHR = 68.2 %, PC = 25.9 %). BS were significantly more prevalent in both EOP and UHR than PC, and UHR were similar to EOP in symptom domains. Given the uncertain outcome of adolescents at clinical high-risk of psychosis, future research is needed to determine whether the combined assessment of early subjective disturbances with observable APS can improve the accuracy of psychosis prediction.
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Affiliation(s)
- Nella Lo Cascio
- Department of Neurosciences and Neurorehabilitation, Bambino Gesù Children's Hospital, Rome, Italy.,Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Riccardo Saba
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Marta Hauser
- The Zucker Hillside Hospital Department of Psychiatry, North Shore-LIJ Health System, 75-59 263rd Street, Glen Oaks, NY, 11004, USA.,Hofstra North Shore-LIJ School of Medicine, Hofstra University, Hempstead, NY, USA.,The Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Ditte Lammers Vernal
- Research Unit for Child and Adolescent Psychiatry, Aalborg University Hospital, North Denmark Region, Denmark
| | - Aseel Al-Jadiri
- The Zucker Hillside Hospital Department of Psychiatry, North Shore-LIJ Health System, 75-59 263rd Street, Glen Oaks, NY, 11004, USA
| | - Yehonatan Borenstein
- The Zucker Hillside Hospital Department of Psychiatry, North Shore-LIJ Health System, 75-59 263rd Street, Glen Oaks, NY, 11004, USA
| | - Eva M Sheridan
- The Zucker Hillside Hospital Department of Psychiatry, North Shore-LIJ Health System, 75-59 263rd Street, Glen Oaks, NY, 11004, USA
| | - Taishiro Kishimoto
- The Zucker Hillside Hospital Department of Psychiatry, North Shore-LIJ Health System, 75-59 263rd Street, Glen Oaks, NY, 11004, USA.,Hofstra North Shore-LIJ School of Medicine, Hofstra University, Hempstead, NY, USA.,The Feinstein Institute for Medical Research, Manhasset, NY, USA.,School of Medicine, Keio University, Tokyo, Japan
| | - Marco Armando
- Department of Neurosciences and Neurorehabilitation, Bambino Gesù Children's Hospital, Rome, Italy
| | - Stefano Vicari
- Department of Neurosciences and Neurorehabilitation, Bambino Gesù Children's Hospital, Rome, Italy
| | - Paolo Fiori Nastro
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Paolo Girardi
- Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, Rome, Italy
| | - Eva Gebhardt
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - John M Kane
- The Zucker Hillside Hospital Department of Psychiatry, North Shore-LIJ Health System, 75-59 263rd Street, Glen Oaks, NY, 11004, USA.,Hofstra North Shore-LIJ School of Medicine, Hofstra University, Hempstead, NY, USA.,The Feinstein Institute for Medical Research, Manhasset, NY, USA.,Albert Einstein College of Medicine, Yeshiva University, Bronx, NY, USA
| | - Andrea Auther
- The Zucker Hillside Hospital Department of Psychiatry, North Shore-LIJ Health System, 75-59 263rd Street, Glen Oaks, NY, 11004, USA.,Hofstra North Shore-LIJ School of Medicine, Hofstra University, Hempstead, NY, USA
| | - Ricardo E Carrión
- The Zucker Hillside Hospital Department of Psychiatry, North Shore-LIJ Health System, 75-59 263rd Street, Glen Oaks, NY, 11004, USA.,Hofstra North Shore-LIJ School of Medicine, Hofstra University, Hempstead, NY, USA.,The Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Barbara A Cornblatt
- The Zucker Hillside Hospital Department of Psychiatry, North Shore-LIJ Health System, 75-59 263rd Street, Glen Oaks, NY, 11004, USA.,Hofstra North Shore-LIJ School of Medicine, Hofstra University, Hempstead, NY, USA.,The Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Benno G Schimmelmann
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Frauke Schultze-Lutter
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Christoph U Correll
- The Zucker Hillside Hospital Department of Psychiatry, North Shore-LIJ Health System, 75-59 263rd Street, Glen Oaks, NY, 11004, USA. .,Hofstra North Shore-LIJ School of Medicine, Hofstra University, Hempstead, NY, USA. .,The Feinstein Institute for Medical Research, Manhasset, NY, USA. .,Albert Einstein College of Medicine, Yeshiva University, Bronx, NY, USA.
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Kindler J, Schultze-Lutter F, Michel C, Martz-Irngartinger A, Linder C, Schmidt SJ, Stegmayer K, Schimmelmann BG, Walther S. Abnormal involuntary movements are linked to psychosis-risk in children and adolescents: Results of a population-based study. Schizophr Res 2016; 174:58-64. [PMID: 27160790 DOI: 10.1016/j.schres.2016.04.032] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 04/19/2016] [Accepted: 04/19/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Altered motor behavior has consistently been reported in medication-naive adult patients with schizophrenia and first episode psychosis and adults at clinical high risk for psychosis (CHR). This study is the first to evaluate the prevalence of abnormal involuntary movements in a community sample of children and adolescents with and without CHR. METHODS We examined CHR in 102 children and adolescents aged 8-17years from the general population of the Canton Bern. Attenuated and brief intermittent psychotic symptoms, as well as basic symptoms, were assessed using the Structured Interview for Psychosis Risk Syndromes and the Schizophrenia Proneness Instrument, Child & Youth Version. Motor symptoms were assessed using the Abnormal Involuntary Movement Scale (AIMS). Additionally, psychosocial functioning, a neurocognitive test battery, and DSM-IV Axis I disorders were examined. RESULTS Eleven (10.8%) participants met CHR criteria, 13 (12.7%, 5 with and 8 without CHR) met criteria for increased abnormal involuntary movements (AIMS≥2). Both AIMS total scores and the percentage of children with AIMS≥2 were significantly higher in the CHR group. Psychosocial functioning was reduced in subjects with abnormal involuntary movements, and movement abnormalities were linked to deficits in attention and perception but not to the presence of non-psychotic mental disorders. CONCLUSIONS Our findings suggest that abnormal involuntary movements are linked to psychosis risk in children and adolescents from the general population. Thus, abnormal involuntary movements might represent an additional useful and easily accessible predictor of psychosis.
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Affiliation(s)
- Jochen Kindler
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, 3000 Bern 60, Switzerland.
| | - Frauke Schultze-Lutter
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, 3000 Bern 60, Switzerland
| | - Chantal Michel
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, 3000 Bern 60, Switzerland
| | - Alexandra Martz-Irngartinger
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, 3000 Bern 60, Switzerland
| | - Caroline Linder
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, 3000 Bern 60, Switzerland
| | - Stefanie J Schmidt
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, 3000 Bern 60, Switzerland
| | - Katharina Stegmayer
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, 3000 Bern 60, Switzerland
| | - Benno G Schimmelmann
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, 3000 Bern 60, Switzerland
| | - Sebastian Walther
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, 3000 Bern 60, Switzerland
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31
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Stentebjerg-Olesen M, Pagsberg AK, Fink-Jensen A, Correll CU, Jeppesen P. Clinical Characteristics and Predictors of Outcome of Schizophrenia-Spectrum Psychosis in Children and Adolescents: A Systematic Review. J Child Adolesc Psychopharmacol 2016; 26:410-27. [PMID: 27136403 DOI: 10.1089/cap.2015.0097] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Treatment of early-onset schizophrenia spectrum psychosis (EOS) is hampered by limited data on clinical presentation and illness course. We aimed to systematically review the clinical characteristics, diagnostic trajectories, and predictors of illness severity and outcomes of EOS. METHODS We conducted a systematic PubMed, PsycINFO, and Embase literature review including studies published from January 1, 1990 to August 8, 2014 of EOS patients with 1) ≥50% nonaffective psychosis cases; 2) mean age of subjects <19 years; 3) clinical samples recruited through mental health services; 4) cross-sectional or prospective design; 5) ≥20 participants at baseline; 6) standardized/validated diagnostic instruments; and 7) quantitative psychotic symptom frequency or severity data. Exploratory analyses assessed associations among relevant clinical variables. RESULTS Across 35 studies covering 28 independent samples (n = 1506, age = 15.6 years, age at illness onset = 14.5 years, males = 62.3%, schizophrenia-spectrum disorders = 89.0%), the most frequent psychotic symptoms were auditory hallucinations (81.9%), delusions (77.5%; mainly persecutory [48.5%], referential [35.1%], and grandiose [25.5%]), thought disorder (65.5%), bizarre/disorganized behavior (52.8%), and flat or blunted affect/negative symptoms (52.3%/50.4%). Mean baseline Positive and Negative Syndrome Scale (PANSS)-total, positive, and negative symptom scores were 84.5 ± 10.9, 19.3 ± 4.4 and 20.8 ± 2.9. Mean baseline Clinical Global Impressions-Severity and Children's Global Assessment Scale/Global Assessment of Functioning (CGAS/GAF) scores were 5.0 ± 0.7 and 35.5 ± 9.1. Comorbidity was frequent, particularly posttraumatic stress disorder (34.3%), attention-deficit/hyperactivity and/or disruptive behavior disorders (33.5%), and substance abuse/dependence (32.0%). Longer duration of untreated psychosis (DUP) predicted less CGAS/GAF improvement (p < 0.0001), and poor premorbid adjustment and a diagnosis of schizophrenia predicted less PANSS negative symptom improvement (p = 0.0048) at follow-up. Five studies directly comparing early-onset with adult-onset psychosis found longer DUP in EOP samples (18.7 ± 6.2 vs. 5.4 ± 3.1 months, p = 0.0027). CONCLUSIONS EOS patients suffer substantial impairment from significant levels of positive and negative symptoms. Although symptoms and functioning improve significantly over time, pre-/and comorbid conditions are frequent, and longer DUP and poorer premorbid adjustment is associated with poorer illness outcome.
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Affiliation(s)
- Marie Stentebjerg-Olesen
- 1 Child and Adolescent Mental Health Center , Mental Health Services, the Capital Region of Denmark, Copenhagen, Denmark .,2 Faculty of Health Science, University of Copenhagen , Copenhagen, Denmark
| | - Anne K Pagsberg
- 1 Child and Adolescent Mental Health Center , Mental Health Services, the Capital Region of Denmark, Copenhagen, Denmark .,2 Faculty of Health Science, University of Copenhagen , Copenhagen, Denmark
| | - Anders Fink-Jensen
- 3 Mental Health Center, Copenhagen University Hospital , Copenhagen, Denmark .,4 Laboratory of Neuropsychiatry, Department of Neuroscience and Pharmacology, University of Copenhagen , Copenhagen, Denmark
| | - Christoph U Correll
- 5 Department of Psychiatry, The Zucker Hillside Hospital , North Shore - Long Island Jewish Health System, Glen Oaks, New York.,6 Department of Psychiatry and Molecular Medicine, Hofstra North Shore-LIJ School of Medicine , Hempstead, New York.,7 The Feinstein Institute for Medical Research , Manhasset, New York.,8 Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine , Bronx, New York
| | - Pia Jeppesen
- 1 Child and Adolescent Mental Health Center , Mental Health Services, the Capital Region of Denmark, Copenhagen, Denmark .,2 Faculty of Health Science, University of Copenhagen , Copenhagen, Denmark
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Chen FP, Gearing RE, DeVylder JE, Oh HY. Pathway model of parental help seeking for adolescents experiencing first-episode psychosis. Early Interv Psychiatry 2016; 10:122-8. [PMID: 24894667 DOI: 10.1111/eip.12159] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 04/29/2014] [Indexed: 11/30/2022]
Abstract
AIM Parents and caregivers are confronted with many challenges when caring for adolescents experiencing first-episode psychosis (FEP). Understanding and support for parental help-seeking process is essential for adolescents' timely access to treatment. The study aimed to develop a pathway model of parental help seeking for adolescents experiencing FEP and identify crucial time points for intervention. METHODS Directed content analysis was conducted on semi-structured qualitative interviews of 16 parents whose children had experienced FEP and focused on parents' experiences prior to and during FEP until first hospitalization. RESULTS The resultant parental help seeking for FEP model included two stages and six phases. The contemplation stage is composed of phases of initial awareness, recognizing severity and considering options. The action stage entailed help-seeking intention, securing help and service appraisal. All parents promptly began help seeking after recognizing severe symptoms and sought advice from professional and community supports, although parents' lack of initial awareness was common. Further analysis on individual parents' help-seeking trajectories showed that among the 50% parents who reported pre-existing childhood conditions, 87.5% did not report initial awareness of psychotic symptoms. CONCLUSIONS Findings recommend intervention at three specific periods of help seeking. First, psychoeducation is needed when parents first engage with health care for their children's disabling conditions. Professionals treating childhood conditions need training to vigilantly monitor the overall mental health of the children over time. Second, it is important to enhance the roles of formal and informal community resources in facilitating parental help seeking. Finally, family-focused interventions are essential in supporting the family for securing needed treatment.
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Affiliation(s)
- Fang-pei Chen
- School of Social Work, Columbia University, New York, New York, USA
| | - Robin E Gearing
- School of Social Work, Columbia University, New York, New York, USA
| | | | - Hans Y Oh
- School of Social Work, Columbia University, New York, New York, USA
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33
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Laurens KR, Cullen AE. Toward earlier identification and preventative intervention in schizophrenia: evidence from the London Child Health and Development Study. Soc Psychiatry Psychiatr Epidemiol 2016; 51:475-91. [PMID: 26670311 PMCID: PMC4823320 DOI: 10.1007/s00127-015-1151-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 11/08/2015] [Indexed: 11/02/2022]
Abstract
PURPOSE The London Child Health and Development Study (CHADS) is a prospective, longitudinal investigation of children, sampled from the general community aged 9-11 years and assessed biennially, who present premorbid risk markers for schizophrenia. The study aims to characterise developmental trajectories of psychological, cognitive, and biological functioning in at-risk children and identify potential targets for early preventative intervention. This review summarises CHADS findings, discusses these in the context of recent theory regarding aetiology and prevention of schizophrenia, and highlights challenges to be addressed with future research. METHODS We review (1) epidemiological information on the prevalence and correlates of developmental antecedents of schizophrenia in the general child population, (2) evidence of psychosocial, cognitive, and biological dysfunctions in at-risk children presenting multiple antecedents of schizophrenia and at-risk children with a family history of schizophrenia, and (3) related findings from an associated sample of help-seeking children receiving intervention. RESULTS Community-based screening of 9-11-year olds identified ~9 % with a triad of antecedents of schizophrenia [including psychotic-like experiences (PLEs)] who are putatively at-risk of psychosis; these children reported greater exposure and responsivity to stressors, impairments in general intelligence and specific cognitive functions, brain structure and function abnormalities, and neuromotor dysfunction. Preliminary evidence suggests distressing PLEs are a viable target for cognitive-behavioural intervention in at-risk children. CONCLUSIONS Intervention in early, premorbid phases of illness might alleviate current difficulties and avert future schizophrenia using benign treatments. The CHADS programme has identified several markers that may index early pathophysiology and constitute potential targets for preventative intervention.
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Affiliation(s)
- Kristin R Laurens
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
- Research Unit for Schizophrenia Epidemiology, School of Psychiatry, University of New South Wales, Sydney, Australia.
- Schizophrenia Research Institute, Sydney, Australia.
| | - Alexis E Cullen
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Gerstenberg M, Theodoridou A, Traber-Walker N, Franscini M, Wotruba D, Metzler S, Müller M, Dvorsky D, Correll CU, Walitza S, Rössler W, Heekeren K. Adolescents and adults at clinical high-risk for psychosis: age-related differences in attenuated positive symptoms syndrome prevalence and entanglement with basic symptoms. Psychol Med 2016; 46:1069-1078. [PMID: 26671170 DOI: 10.1017/s0033291715002627] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND The attenuated positive symptoms syndrome (APSS) is considered an at-risk indicator for psychosis. However, the characteristics and developmental aspects of the combined or enriched risk criteria of APSS and basic symptom (BS) criteria, including self-experienced cognitive disturbances (COGDIS) remain under-researched. METHOD Based on the Structured Interview of Prodromal Syndromes (SIPS), the prevalence of APSS in 13- to 35-year-old individuals seeking help in an early recognition program for schizophrenia and bipolar-spectrum disorders was examined. BS criteria and COGDIS were rated using the Schizophrenia Proneness Instrument for Adults/Children and Youth. Participants meeting APSS criteria were compared with participants meeting only BS criteria across multiple characteristics. Co-occurrence (APSS+/BS+, APSS+/COGDIS+) was compared across 13-17, 18-22 and 23-35 years age groups. RESULTS Of 175 individuals (age = 20.6 ± 5.8, female = 38.3%), 94 (53.7%) met APSS criteria. Compared to BS, APSS status was associated with suicidality, higher illness severity, lower functioning, higher SIPS positive, negative, disorganized and general symptoms scores, depression scores and younger age (18.3 ± 5.0 v. 23.2 ± 5.6 years, p < 0.0001) with age-related differences in the prevalence of APSS (ranging from 80.3% in 13- to 17-year-olds to 33.3% in 23- to 35-year-olds (odds ratio 0.21, 95% confidence interval 0.11-0.37). Within APSS+ individuals, fewer adolescents fulfilled combined risk criteria of APSS+/BS+ or APSS+/COGDIS+ compared to the older age groups. CONCLUSIONS APSS status was associated with greater suicidality and illness/psychophathology severity in this help-seeking cohort, emphasizing the need for clinical care. The age-related differences in the prevalence of APSS and the increasing proportion of APSS+/COGDIS+ may point to a higher proportion of non-specific/transient, rather than risk-specific attenuated positive symptoms in adolescents.
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Affiliation(s)
- M Gerstenberg
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP),University Hospital of Psychiatry Zurich,Zurich,Switzerland
| | - A Theodoridou
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP),University Hospital of Psychiatry Zurich,Zurich,Switzerland
| | - N Traber-Walker
- University Clinics for Child and Adolescent Psychiatry Zurich,Zurich,Switzerland
| | - M Franscini
- University Clinics for Child and Adolescent Psychiatry Zurich,Zurich,Switzerland
| | - D Wotruba
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP),University Hospital of Psychiatry Zurich,Zurich,Switzerland
| | - S Metzler
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP),University Hospital of Psychiatry Zurich,Zurich,Switzerland
| | - M Müller
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP),University Hospital of Psychiatry Zurich,Zurich,Switzerland
| | - D Dvorsky
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP),University Hospital of Psychiatry Zurich,Zurich,Switzerland
| | - C U Correll
- The Zucker Hillside Hospital,Psychiatry Research,North Shore - Long Island Jewish Health System (LIJ),Glen Oaks,NY,USA
| | - S Walitza
- University Clinics for Child and Adolescent Psychiatry Zurich,Zurich,Switzerland
| | - W Rössler
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP),University Hospital of Psychiatry Zurich,Zurich,Switzerland
| | - K Heekeren
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP),University Hospital of Psychiatry Zurich,Zurich,Switzerland
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Woodberry KA, Shapiro DI, Bryant C, Seidman LJ. Progress and Future Directions in Research on the Psychosis Prodrome: A Review for Clinicians. Harv Rev Psychiatry 2016; 24:87-103. [PMID: 26954594 PMCID: PMC4870599 DOI: 10.1097/hrp.0000000000000109] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
LEARNING OBJECTIVES After participating in this activity, learners should be better able to: ABSTRACT The psychosis prodrome, or period of clinical and functional decline leading up to acute psychosis, offers a unique opportunity for identifying mechanisms of psychosis onset and for testing early-intervention strategies. We summarize major findings and emerging directions in prodromal research and provide recommendations for clinicians working with individuals suspected to be at high risk for psychosis. The past two decades of research have led to three major advances. First, tools and criteria have been developed that can reliably identify imminent risk for a psychotic disorder. Second, longitudinal clinical and psychobiological data from large multisite studies are strengthening individual risk assessment and offering insights into potential mechanisms of illness onset. Third, psychosocial and pharmacological interventions are demonstrating promise for delaying or preventing the onset of psychosis in help-seeking, high-risk individuals. The dynamic psychobiological processes implicated in both risk and onset of psychosis, including altered gene expression, cognitive dysfunction, inflammation, gray and white matter brain changes, and vulnerability-stress interactions suggest a wide range of potential treatment targets and strategies. The expansion of resources devoted to early intervention and prodromal research worldwide raises hope for investigating them. Future directions include identifying psychosis-specific risk and resilience factors in children, adolescents, and non-help-seeking community samples, improving study designs to test hypothesized mechanisms of change, and intervening with strategies that, in order to improve functional outcomes, better engage youth, address their environmental contexts, and focus on evidence-based neurodevelopmental targets. Prospective research on putatively prodromal samples has the potential to substantially reshape our understanding of mental illness and our efforts to combat it.
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Affiliation(s)
- Kristen A Woodberry
- From Harvard Medical School (Drs. Woodberry, Shapiro, and Seidman) and Beth Israel Deaconess Medical Center (Drs. Woodberry, Shapiro, and Seidman, and Ms. Bryant)
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MacKenzie LE, Abidi S, Fisher HL, Propper L, Bagnell A, Morash-Conway J, Glover JM, Cumby J, Hajek T, Schultze-Lutter F, Pajer K, Alda M, Uher R. Stimulant Medication and Psychotic Symptoms in Offspring of Parents With Mental Illness. Pediatrics 2016; 137:peds.2015-2486. [PMID: 26719291 DOI: 10.1542/peds.2015-2486] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/20/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Stimulants, such as methylphenidate, are among the most commonly used medications in children and adolescents. Psychotic symptoms have been reported as rare adverse reactions to stimulants but have not been systematically inquired about in most previous studies. Family history of mental illness may increase the vulnerability to drug-induced psychotic symptoms. We examined the association between stimulant use and psychotic symptoms in sons and daughters of parents with major mood and psychotic disorders. METHODS We assessed psychotic symptoms, psychotic-like experiences, and basic symptoms in 141 children and youth (mean ± SD age: 11.8 ± 4.0 years; range: 6-21 years), who had 1 or both parents with major depressive disorder, bipolar disorder, or schizophrenia, and of whom 24 (17.0%) had taken stimulant medication. RESULTS Psychotic symptoms were present in 62.5% of youth who had taken stimulants compared with 27.4% of participants who had never taken stimulants. The association between stimulant use and psychotic experiences remained significant after adjustment for potential confounders (odds ratio: 4.41; 95% confidence interval: 1.82-10.69; P = .001) and was driven by hallucinations occurring during the use of stimulant medication. A temporal relationship between use of stimulants and psychotic symptoms was supported by an association between current stimulant use and current psychotic symptoms and co-occurrence in cases that were assessed on and off stimulants. CONCLUSIONS Psychotic symptoms should be monitored during the use of stimulants in children and adolescents. Family history of mood and psychotic disorders may need to be taken into account when considering the prescription of stimulants.
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Affiliation(s)
- Lynn E MacKenzie
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada; IWK Health Centre, Halifax, Nova Scotia, Canada; Departments of Psychiatry, Psychology and Neuroscience
| | - Sabina Abidi
- IWK Health Centre, Halifax, Nova Scotia, Canada; Departments of Psychiatry
| | - Helen L Fisher
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; and
| | - Lukas Propper
- IWK Health Centre, Halifax, Nova Scotia, Canada; Departments of Psychiatry
| | - Alexa Bagnell
- IWK Health Centre, Halifax, Nova Scotia, Canada; Departments of Psychiatry
| | | | | | - Jill Cumby
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Tomas Hajek
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada; Departments of Psychiatry
| | - Frauke Schultze-Lutter
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Kathleen Pajer
- IWK Health Centre, Halifax, Nova Scotia, Canada; Departments of Psychiatry
| | - Martin Alda
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada; Departments of Psychiatry
| | - Rudolf Uher
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada; IWK Health Centre, Halifax, Nova Scotia, Canada; Departments of Psychiatry, Psychology and Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; and Medical Neuroscience, and Public Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada;
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Identifying children and adolescents at ultra high risk of psychosis in Italian neuropsychiatry services: a feasibility study. Eur Child Adolesc Psychiatry 2016; 25:91-106. [PMID: 25925786 DOI: 10.1007/s00787-015-0710-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 04/07/2015] [Indexed: 12/20/2022]
Abstract
The past 20 years have seen the evolution of the construct of a clinical high-risk (hereafter, HR) state for psychosis. This construct is designed to capture the pre-psychotic phase. Some aspects of this approach, such as its feasibility in children and adolescents, are still under investigation. In the present study, we address the feasibility of implementing prodrome clinics for HR individuals within the framework of Italy's national child and adolescent neuropsychiatry services and the clinical relevance of a HR diagnosis in this population. Using the Comprehensive Assessment of At-Risk Mental States (CAARMS) to identify help-seeking patients meeting at least one HR criterion at baseline (HR+), we recruited 50 subjects for a feasibility study. The results obtained show that the Italian version of the CAARMS is easily administrable, causing patients no substantial discomfort. The prevalence of HR+ in our cohort was 44 %, which increased by an additional 18 % when negative symptoms were considered as an experimental inclusion criterion (HRNeg). The HR+ subjects were significantly more impaired in their social and occupational functioning than their HR- peers (subjects not at HR). The cumulative 1-year transition risk of psychosis of the HR+ group was 26.7 %. When the HRNeg group was added, the 1-year transition risk was 17.3 %. We suggest that administration of the CAARMS to children and adolescents with putative prodromal psychosis is feasible and that this assessment can easily be integrated into existing Italian neuropsychiatry services although clinicians should interpret results with caution as results in this age group still have to be replicated.
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Armando M, Pontillo M, De Crescenzo F, Mazzone L, Monducci E, Lo Cascio N, Santonastaso O, Pucciarini ML, Vicari S, Schimmelmann BG, Schultze-Lutter F. Twelve-month psychosis-predictive value of the ultra-high risk criteria in children and adolescents. Schizophr Res 2015; 169:186-192. [PMID: 26526751 DOI: 10.1016/j.schres.2015.10.033] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 10/19/2015] [Accepted: 10/22/2015] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The validity of current ultra-high risk (UHR) criteria is under-examined in help-seeking minors, particularly, in children below the age of 12 years. Thus, the present study investigated predictors of one-year outcome in children and adolescents (CAD) with UHR status. METHOD Thirty-five children and adolescents (age 9-17 years) meeting UHR criteria according to the Structured Interview for Psychosis-Risk Syndromes were followed-up for 12 months. Regression analyses were employed to detect baseline predictors of conversion to psychosis and of outcome of non-converters (remission and persistence of UHR versus conversion). RESULTS At one-year follow-up, 20% of patients had developed schizophrenia, 25.7% had remitted from their UHR status that, consequently, had persisted in 54.3%. No patient had fully remitted from mental disorders, even if UHR status was not maintained. Conversion was best predicted by any transient psychotic symptom and a disorganized communication score. No prediction model for outcome beyond conversion was identified. CONCLUSIONS Our findings provide the first evidence for the predictive utility of UHR criteria in CAD in terms of brief intermittent psychotic symptoms (BIPS) when accompanied by signs of cognitive impairment, i.e. disorganized communication. However, because attenuated psychotic symptoms (APS) related to thought content and perception were indicative of non-conversion at 1-year follow-up, their use in early detection of psychosis in CAD needs further study. Overall, the need for more in-depth studies into developmental peculiarities in the early detection and treatment of psychoses with an onset of illness in childhood and early adolescence was further highlighted.
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Affiliation(s)
- Marco Armando
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Piazza Sant'Onofrio 4, 00100 Rome, Italy; Office Médico-Pédagogique Research Unit, Department of Psychiatry, University of Geneva School of Medicine, Geneva, Switzerland.
| | - Maria Pontillo
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Piazza Sant'Onofrio 4, 00100 Rome, Italy
| | - Franco De Crescenzo
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Piazza Sant'Onofrio 4, 00100 Rome, Italy
| | - Luigi Mazzone
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Piazza Sant'Onofrio 4, 00100 Rome, Italy
| | - Elena Monducci
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Piazza Sant'Onofrio 4, 00100 Rome, Italy
| | - Nella Lo Cascio
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Piazza Sant'Onofrio 4, 00100 Rome, Italy; Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Ornella Santonastaso
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Piazza Sant'Onofrio 4, 00100 Rome, Italy
| | - Maria Laura Pucciarini
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Piazza Sant'Onofrio 4, 00100 Rome, Italy
| | - Stefano Vicari
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Piazza Sant'Onofrio 4, 00100 Rome, Italy
| | - Benno G Schimmelmann
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111 (Haus A), 3000 Bern 60, Switzerland
| | - Frauke Schultze-Lutter
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111 (Haus A), 3000 Bern 60, Switzerland
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Vernal DL, Kapoor S, Al-Jadiri A, Sheridan EM, Borenstein Y, Mormando C, David L, Singh S, Seidman AJ, Carbon M, Gerstenberg M, Saito E, Kane JM, Steinhausen HC, Correll CU. Outcome of Youth with Early-Phase Schizophrenia-Spectrum Disorders and Psychosis Not Otherwise Specified Treated with Second-Generation Antipsychotics: 12 Week Results from a Prospective, Naturalistic Cohort Study. J Child Adolesc Psychopharmacol 2015; 25:535-47. [PMID: 26375767 PMCID: PMC4696429 DOI: 10.1089/cap.2014.0164] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES The purpose of this study was to assess differences in the outcomes of youth with schizophrenia-spectrum disorders (SCZ-S) and psychotic disorder not otherwise specified (PsyNOS) during early antipsychotic treatment. METHODS The study was a prospective, naturalistic, inception cohort study of youth ≤19 years old with SCZ-S (schizophrenia, schizoaffective disorder, schizophreniform disorder) or PsyNOS (PsyNOS, brief psychotic disorder) and ≤24 months of lifetime antipsychotic treatment receiving clinician's choice antipsychotic treatment. Baseline demographic, illness and treatment variables, and effectiveness outcomes were compared at 12 weeks last-observation-carried-forward across SCZ-S and PsyNOS patients, adjusting for significantly different baseline variables. RESULTS Altogether, 130 youth with SCZ-S (n=42) or PsyNOS (n=88), mostly antipsychotic naïve (76.9%), were prescribed risperidone (47.7%), olanzapine (19.2%), aripiprazole (14.6%), quetiapine (11.5%), or ziprasidone (6.9%). Compared with those with PsyNOS, SCZ-S youth were older (16.4±2.1 vs. 14.8±3.2, p=0.0040), and less likely to be Caucasian (19.1% vs. 42.5%, p=0.009). At baseline, SCZ-S patients had significantly higher Clinical Global Impressions-Severity (CGI-S) scores (6.0±0.9 vs. 5.5±0.8, p=0.0018) and lower Children's Global Assessment Scale (CGAS) scores (29.6±9.2 vs. 36.1±8.9, p=0.0002) and were more likely to be in the severely ill CGAS group (i.e., CGAS≤40). SCZ-S and PsyNOS patients did not differ regarding all-cause discontinuation (40.5 vs. 40.3%. p=0.49), discontinuation because of adverse effects (12.2% vs. 12.4%, p=0.97), or nonadherence (29.3% vs. 30.9%, p=0.88), but somewhat more SCZ-S patients discontinued treatment for inefficacy (19.5% vs. 7.4%, p=0.063). CGI-S and CGAS scores improved significantly in both diagnostic groups (p=0.0001, each). Adjusting for baseline differences, PsyNOS patients experienced significantly better CGI-I improvement (CGI-I) scores (p=0.012) and more frequently reached higher categorical CGAS group status (p=0.021) than SCZ-S patients. CONCLUSIONS Both youth with SCZ-S and those with PsyNOS experienced significant improvements with clinician's choice antipsychotic treatment. However, treatment discontinuation was common within 12 weeks, with greater inefficacy-related discontinuation in the SCZ-S group, whereas CGI-I and CGAS score-based improvements were greater in the PsyNOS group.
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Affiliation(s)
- Ditte L. Vernal
- Research Unit for Child and Adolescent Psychiatry, Psychiatric Hospital, Aalborg University Hospital, Denmark.,The Zucker Hillside Hospital, Psychiatry Research, North Shore–Long Island Jewish Health System, Glen Oaks, New York
| | - Sandeep Kapoor
- The Zucker Hillside Hospital, Psychiatry Research, North Shore–Long Island Jewish Health System, Glen Oaks, New York
| | - Aseel Al-Jadiri
- The Zucker Hillside Hospital, Psychiatry Research, North Shore–Long Island Jewish Health System, Glen Oaks, New York
| | - Eva M. Sheridan
- The Zucker Hillside Hospital, Psychiatry Research, North Shore–Long Island Jewish Health System, Glen Oaks, New York
| | - Yehonathan Borenstein
- The Zucker Hillside Hospital, Psychiatry Research, North Shore–Long Island Jewish Health System, Glen Oaks, New York
| | - Charles Mormando
- The Zucker Hillside Hospital, Psychiatry Research, North Shore–Long Island Jewish Health System, Glen Oaks, New York
| | - Lisa David
- The Zucker Hillside Hospital, Psychiatry Research, North Shore–Long Island Jewish Health System, Glen Oaks, New York
| | - Sukhbir Singh
- The Zucker Hillside Hospital, Psychiatry Research, North Shore–Long Island Jewish Health System, Glen Oaks, New York
| | - Andrew J. Seidman
- The Zucker Hillside Hospital, Psychiatry Research, North Shore–Long Island Jewish Health System, Glen Oaks, New York
| | - Maren Carbon
- The Zucker Hillside Hospital, Psychiatry Research, North Shore–Long Island Jewish Health System, Glen Oaks, New York
| | - Miriam Gerstenberg
- University Clinics of Child and Adolescent Psychiatry, University of Zurich, Switzerland
| | - Ema Saito
- The Zucker Hillside Hospital, Psychiatry Research, North Shore–Long Island Jewish Health System, Glen Oaks, New York
| | - John M. Kane
- The Zucker Hillside Hospital, Psychiatry Research, North Shore–Long Island Jewish Health System, Glen Oaks, New York.,Hofstra North Shore-LIJ School of Medicine, Hempstead, New York.,Albert Einstein College of Medicine, Bronx, New York.,The Feinstein Institute for Medical Research, Manhasset, New York
| | - Hans-Christoph Steinhausen
- Research Unit for Child and Adolescent Psychiatry, Psychiatric Hospital, Aalborg University Hospital, Denmark.,Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Switzerland.,Department of Child and Adolescent Psychiatry, University of Zurich, Switzerland
| | - Christoph U. Correll
- The Zucker Hillside Hospital, Psychiatry Research, North Shore–Long Island Jewish Health System, Glen Oaks, New York.,Hofstra North Shore-LIJ School of Medicine, Hempstead, New York.,Albert Einstein College of Medicine, Bronx, New York.,The Feinstein Institute for Medical Research, Manhasset, New York
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Schimmelmann BG, Michel C, Martz-Irngartinger A, Linder C, Schultze-Lutter F. Age matters in the prevalence and clinical significance of ultra-high-risk for psychosis symptoms and criteria in the general population: Findings from the BEAR and BEARS-kid studies. World Psychiatry 2015; 14:189-97. [PMID: 26043337 PMCID: PMC4471976 DOI: 10.1002/wps.20216] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Early detection of psychosis is an important topic in psychiatry. Yet, there is limited information on the prevalence and clinical significance of high-risk symptoms in children and adolescents as compared to adults. We examined ultra-high-risk (UHR) symptoms and criteria in a sample of individuals aged 8-40 years from the general population of Canton Bern, Switzerland, enrolled from June 2011 to May 2014. The current presence of attenuated psychotic symptoms (APS) and brief intermittent psychotic symptoms (BLIPS) and the fulfillment of onset/worsening and frequency requirements for these symptoms in UHR criteria were assessed using the Structured Interview for Psychosis Risk Syndromes. Additionally, perceptive and non-perceptive APS were differentiated. Psychosocial functioning and current non-psychotic DSM-IV axis I disorders were also surveyed. Well-trained psychologists performed assessments. Altogether, 9.9% of subjects reported APS and none BLIPS, and 1.3% met all the UHR requirements for APS. APS were related to more current axis I disorders and impaired psychosocial functioning, indicating some clinical significance. A strong age effect was detected around age 16: compared to older individuals, 8-15-year olds reported more perceptive APS, that is, unusual perceptual experiences and attenuated hallucinations. Perceptive APS were generally less related to functional impairment, regardless of age. Conversely, non-perceptive APS were related to low functioning, although this relationship was weaker in those below age 16. Future studies should address the differential effects of perceptive and non-perceptive APS, and their interaction with age, also in terms of conversion to psychosis.
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Affiliation(s)
- Benno G Schimmelmann
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of BernBolligenstrasse 111, 3000 Bern 60, Switzerland
| | - Chantal Michel
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of BernBolligenstrasse 111, 3000 Bern 60, Switzerland
| | - Alexandra Martz-Irngartinger
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of BernBolligenstrasse 111, 3000 Bern 60, Switzerland
| | - Caroline Linder
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of BernBolligenstrasse 111, 3000 Bern 60, Switzerland
| | - Frauke Schultze-Lutter
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of BernBolligenstrasse 111, 3000 Bern 60, Switzerland
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Reisinger S, Khan D, Kong E, Berger A, Pollak A, Pollak DD. The poly(I:C)-induced maternal immune activation model in preclinical neuropsychiatric drug discovery. Pharmacol Ther 2015; 149:213-26. [PMID: 25562580 DOI: 10.1016/j.pharmthera.2015.01.001] [Citation(s) in RCA: 160] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 12/30/2014] [Indexed: 12/28/2022]
Abstract
Increasing epidemiological and experimental evidence implicates gestational infections as one important factor involved in the pathogenesis of several neuropsychiatric disorders. Corresponding preclinical model systems based upon maternal immune activation (MIA) by treatment of the pregnant female have been developed. These MIA animal model systems have been successfully used in basic and translational research approaches, contributing to the investigation of the underlying pathophysiological mechanisms at the molecular, cellular and behavioral levels. The present article focuses on the application of a specific MIA rodent paradigm, based upon treatment of the gestating dam with the viral mimic polyinosinic-polycytidilic acid (Poly(I:C)), a synthetic analog of double-stranded RNA (dsRNA) which activates the Toll-like receptor 3 (TLR3) pathway. Important advantages and constraints of this animal model will be discussed, specifically in light of gestational infection as one vulnerability factor contributing to the complex etiology of mood and psychotic disorders, which are likely the result of intricate multi-level gene×environment interactions. Improving our currently incomplete understanding of the molecular pathomechanistic principles underlying these disorders is a prerequisite for the development of alternative therapeutic approaches which are critically needed in light of the important drawbacks and limitations of currently available pharmacological treatment options regarding efficacy and side effects. The particular relevance of the Poly(I:C) MIA model for the discovery of novel drug targets for symptomatic and preventive therapeutic strategies in mood and psychotic disorders is highlighted in this review article.
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Affiliation(s)
- Sonali Reisinger
- Department of Neurophysiology and Neuropharmacology, Medical University of Vienna, Austria
| | - Deeba Khan
- Department of Neurophysiology and Neuropharmacology, Medical University of Vienna, Austria
| | - Eryan Kong
- Department of Neurophysiology and Neuropharmacology, Medical University of Vienna, Austria
| | - Angelika Berger
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Austria
| | - Arnold Pollak
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Austria
| | - Daniela D Pollak
- Department of Neurophysiology and Neuropharmacology, Medical University of Vienna, Austria.
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Jeppesen P, Clemmensen L, Munkholm A, Rimvall MK, Rask CU, Jørgensen T, Larsen JT, Petersen L, van Os J, Skovgaard AM. Psychotic experiences co-occur with sleep problems, negative affect and mental disorders in preadolescence. J Child Psychol Psychiatry 2015; 56:558-65. [PMID: 25156482 DOI: 10.1111/jcpp.12319] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/17/2014] [Indexed: 01/25/2023]
Abstract
BACKGROUND Knowledge on the significance of childhood psychotic symptoms and experiences (PE) is still limited. This study aimed to investigate the prevalence and clinical significance of PE in preadolescent children from the general population by use of in-depth psychopathological interviews and comprehensive diagnostic assessments. METHODS We investigated 1,632 children from the general population-based Copenhagen Child Cohort 2000. PE were measured by semistructured interviews using the K-SADS-PL-items on psychotic and affective symptoms, each symptom scored as not present versus likely or definitely present. The Development and Well-Being Assessment (DAWBA) was used independently to diagnose DSM-IV-mental disorders. Puberty development and sleep disturbance were self-reported. The associations between PE (any lifetime hallucination and/or delusion) and various mental problems and disorders were examined by multivariable binomial regression analyses, adjusting for gender and onset of puberty. RESULTS The weighted life time prevalence of PE at age 11-12 years was 10.9% (CI 9.1-12.7). The majority of children with PE (n = 172) either had a diagnosable DSM-IV-mental disorder (31.4%) or self-reported mental health difficulties in absence of a diagnosis (31.4%). The risk of delusions increased with onset of puberty. The risk of PE increased with emotional and neurodevelopmental disorders, subthreshold depressive symptoms, sleep problems and lack of sleep, regardless of whether PE were expressed as hallucinations and/or delusions. The highest correlations were seen for emotional and multiple disorders. CONCLUSIONS Psychotic experiences are particularly prevalent in the context of affective dysregulation and sleep disturbance, increase with onset of puberty and represent a trans-diagnostic marker of psychopathology.
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Affiliation(s)
- Pia Jeppesen
- Child and Adolescent Mental Health Center, Mental Health Services, the Capital Region of Denmark, Glostrup, Denmark; Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
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Debbané M, Eliez S, Badoud D, Conus P, Flückiger R, Schultze-Lutter F. Developing psychosis and its risk states through the lens of schizotypy. Schizophr Bull 2015; 41 Suppl 2:S396-407. [PMID: 25548386 PMCID: PMC4373628 DOI: 10.1093/schbul/sbu176] [Citation(s) in RCA: 145] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Starting from the early descriptions of Kraepelin and Bleuler, the construct of schizotypy was developed from observations of aberrations in nonpsychotic family members of schizophrenia patients. In contemporary diagnostic manuals, the positive symptoms of schizotypal personality disorder were included in the ultra high-risk (UHR) criteria 20 years ago, and nowadays are broadly employed in clinical early detection of psychosis. The schizotypy construct, now dissociated from strict familial risk, also informed research on the liability to develop any psychotic disorder, and in particular schizophrenia-spectrum disorders, even outside clinical settings. Against the historical background of schizotypy it is surprising that evidence from longitudinal studies linking schizotypy, UHR, and conversion to psychosis has only recently emerged; and it still remains unclear how schizotypy may be positioned in high-risk research. Following a comprehensive literature search, we review 18 prospective studies on 15 samples examining the evidence for a link between trait schizotypy and conversion to psychosis in 4 different types of samples: general population, clinical risk samples according to UHR and/or basic symptom criteria, genetic (familial) risk, and clinical samples at-risk for a nonpsychotic schizophrenia-spectrum diagnosis. These prospective studies underline the value of schizotypy in high-risk research, but also point to the lack of evidence needed to better define the position of the construct of schizotypy within a developmental psychopathology perspective of emerging psychosis and schizophrenia-spectrum disorders.
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Affiliation(s)
| | - Stephan Eliez
- Office Médico-Pédagogique Research Unit, Department of Psychiatry, University of Geneva School of Medicine, Geneva, Switzerland
| | - Deborah Badoud
- Developmental Clinical Psychology Research Unit, Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland;,Office Médico-Pédagogique Research Unit, Department of Psychiatry, University of Geneva School of Medicine, Geneva, Switzerland
| | - Philippe Conus
- Department of Psychiatry, Service of General Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Rahel Flückiger
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Frauke Schultze-Lutter
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
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Schultze-Lutter F, Michel C, Schmidt SJ, Schimmelmann BG, Maric NP, Salokangas RKR, Riecher-Rössler A, van der Gaag M, Nordentoft M, Raballo A, Meneghelli A, Marshall M, Morrison A, Ruhrmann S, Klosterkötter J. EPA guidance on the early detection of clinical high risk states of psychoses. Eur Psychiatry 2015; 30:405-16. [PMID: 25735810 DOI: 10.1016/j.eurpsy.2015.01.010] [Citation(s) in RCA: 237] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 01/29/2015] [Accepted: 01/29/2015] [Indexed: 01/15/2023] Open
Abstract
The aim of this guidance paper of the European Psychiatric Association is to provide evidence-based recommendations on the early detection of a clinical high risk (CHR) for psychosis in patients with mental problems. To this aim, we conducted a meta-analysis of studies reporting on conversion rates to psychosis in non-overlapping samples meeting any at least any one of the main CHR criteria: ultra-high risk (UHR) and/or basic symptoms criteria. Further, effects of potential moderators (different UHR criteria definitions, single UHR criteria and age) on conversion rates were examined. Conversion rates in the identified 42 samples with altogether more than 4000 CHR patients who had mainly been identified by UHR criteria and/or the basic symptom criterion 'cognitive disturbances' (COGDIS) showed considerable heterogeneity. While UHR criteria and COGDIS were related to similar conversion rates until 2-year follow-up, conversion rates of COGDIS were significantly higher thereafter. Differences in onset and frequency requirements of symptomatic UHR criteria or in their different consideration of functional decline, substance use and co-morbidity did not seem to impact on conversion rates. The 'genetic risk and functional decline' UHR criterion was rarely met and only showed an insignificant pooled sample effect. However, age significantly affected UHR conversion rates with lower rates in children and adolescents. Although more research into potential sources of heterogeneity in conversion rates is needed to facilitate improvement of CHR criteria, six evidence-based recommendations for an early detection of psychosis were developed as a basis for the EPA guidance on early intervention in CHR states.
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Affiliation(s)
- F Schultze-Lutter
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - C Michel
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - S J Schmidt
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - B G Schimmelmann
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - N P Maric
- School of Medicine, University of Belgrade and Clinic of Psychiatry, Clinical Center of Serbia, Belgrade, Serbia
| | | | - A Riecher-Rössler
- Center for Gender Research and Early Detection, Psychiatric University Clinics Basel, Basel, Switzerland
| | - M van der Gaag
- Department of Clinical Psychology, VU University and EMGO Institute for Health and Care Research, Amsterdam, The Netherlands; Psychosis Research, Parnassia Psychiatric Institute, The Hague, The Netherlands
| | - M Nordentoft
- Mental Health Center Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - A Raballo
- Department of Mental Health, Reggio Emilia Public Health Centre, Reggio Emilia, Italy; Regional Working Group on Early Detection of Psychosis, Emilia Romagna Regional Health Service, Bologna, Italy
| | - A Meneghelli
- Dipartimento di Salute Mentale, Centro per l'Individuazione e l'Intervento Precoce nelle Psicosi-Programma 2000, Ospedale Niguarda Ca' Granda, Milan, Italy
| | - M Marshall
- School of Medicine, University of Manchester, Manchester, UK; LANTERN Centre, Lancashire Care NHS Foundation Trust, Preston, UK
| | - A Morrison
- School of Psychological Sciences, University of Manchester, Manchester, UK; Psychosis Research Unit, Greater Manchester West NHS Mental Health Trust, Manchester, UK
| | - S Ruhrmann
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - J Klosterkötter
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany.
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Metzler S, Dvorsky D, Wyss C, Müller M, Traber-Walker N, Walitza S, Theodoridou A, Rössler W, Heekeren K. Neurocognitive profiles in help-seeking individuals: comparison of risk for psychosis and bipolar disorder criteria. Psychol Med 2014; 44:3543-3555. [PMID: 25066246 DOI: 10.1017/s0033291714001007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Neurocognitive deficits are important aspects of the schizophrenic disorders because they have a strong impact on social and vocational outcomes. We expanded on previous research by focusing on the neurocognitive profiles of persons at high risk (HR) or ultra-high risk (UHR) for schizophrenic and affective psychoses. Our main aim was to determine whether neurocognitive measures are sufficiently sensitive to predict a group affiliation based on deficits in functional domains. METHOD This study included 207 help-seeking individuals identified as HR (n = 75), UHR (n = 102) or at high risk for bipolar disorder (HRBip; n = 30), who were compared with persons comprising a matched, healthy control group (CG; n = 50). Neuropsychological variables were sorted according to their load in a factor analysis and were compared among groups. In addition, the likelihood of group membership was estimated using logistic regression analyses. RESULTS The performance of HR and HRBip participants was comparable, and intermediate between the controls and UHR. The domain of processing speed was most sensitive in discriminating HR and UHR [odds ratio (OR) 0.48, 95% confidence interval (CI) 0.28-0.78, p = 0.004] whereas learning and memory deficits predicted a conversion to schizophrenic psychosis (OR 0.47, 95% CI 0.25-0.87, p = 0.01). CONCLUSIONS Performances on neurocognitive tests differed among our three at-risk groups and may therefore be useful in predicting psychosis. Overall, cognition had a profound effect on the extent of general functioning and satisfaction with life for subjects at risk of psychosis. Thus, this factor should become a treatment target in itself.
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Affiliation(s)
- S Metzler
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP),University Hospital of Psychiatry Zurich,Switzerland
| | - D Dvorsky
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP),University Hospital of Psychiatry Zurich,Switzerland
| | - C Wyss
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP),University Hospital of Psychiatry Zurich,Switzerland
| | - M Müller
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP),University Hospital of Psychiatry Zurich,Switzerland
| | - N Traber-Walker
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP),University Hospital of Psychiatry Zurich,Switzerland
| | - S Walitza
- Department of Child and Adolescent Psychiatry,University of Zurich,Switzerland
| | - A Theodoridou
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP),University Hospital of Psychiatry Zurich,Switzerland
| | - W Rössler
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP),University Hospital of Psychiatry Zurich,Switzerland
| | - K Heekeren
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP),University Hospital of Psychiatry Zurich,Switzerland
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Brandizzi M, Schultze-Lutter F, Masillo A, Lanna A, Curto M, Lindau JF, Solfanelli A, Listanti G, Patanè M, Kotzalidis G, Gebhardt E, Meyer N, Di Pietro D, Leccisi D, Girardi P, Fiori Nastro P. Self-reported attenuated psychotic-like experiences in help-seeking adolescents and their association with age, functioning and psychopathology. Schizophr Res 2014; 160:110-7. [PMID: 25458860 DOI: 10.1016/j.schres.2014.10.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 09/13/2014] [Accepted: 10/07/2014] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Self-rated attenuated psychotic-like experiences (APLEs) are increasingly used to screen for ultra-high-risk (UHR) across all ages. However, self-rated psychotic-like experiences (PLEs), in particular perception-related ones, were more frequent in children and adolescents, in which they possessed less clinical significance. We therefore explored the prevalence of different factors of APLEs in help-seeking adolescents, and their relationship with age, functioning and psychopathology. METHOD As a part of the "Liberiamo il Futuro" project, help-seeking adolescents (N=171; 11-18 years, 53% male) were screened with the 92-item Prodromal Questionnaire (PQ-92). A factor analysis was performed on the PQ-92 positive items (i.e., APLEs) to identify different APLE-factors. These were assessed for their association with age, functioning and psychopathology using regression analyses. RESULTS APLEs were very common in help-seeking adolescents, and formed four factors: "Conceptual Disorganization and Suspiciousness", "Perceptual Abnormalities", "Bizarre Experiences", and "Magical Ideation". Associations with age and functioning but not psychopathology were found for "Perceptual Abnormalities" that was significantly more severe in 11-12-year-olds, while "Conceptual Disorganization and Suspiciousness" was significantly related to psychopathology. CONCLUSION In line with findings on PLEs, prevalence and clinical significance of APLEs, especially perception-related ones, might depend on age and thus neurodevelopmental stage, and may fall within the normal spectrum of experience during childhood. This should be considered when screening for UHR status in younger age groups.
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Affiliation(s)
- Martina Brandizzi
- Neurosciences, Mental Health and Sensory Functions (NESMOS) Department, Sapienza University of Rome, Faculty of Medicine and Psychology, Sant'Andrea Hospital, Via di Grottarossa 1035, 00189 Rome, Italy; Department of Neurology and Psychiatry, Sapienza University of Rome, Faculty of Medicine and Odontology, Rome 00156, Italy.
| | - Frauke Schultze-Lutter
- University Hospital for Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstr. 111, Haus A 3000 Bern 60, Bern, Switzerland
| | - Alice Masillo
- Department of Neurology and Psychiatry, Sapienza University of Rome, Faculty of Medicine and Odontology, Rome 00156, Italy
| | - Andrea Lanna
- Department of Computer, Control, and Management Engineering "A. Ruberti", Sapienza University of Rome, Rome 00185, Italy
| | - Martina Curto
- Neurosciences, Mental Health and Sensory Functions (NESMOS) Department, Sapienza University of Rome, Faculty of Medicine and Psychology, Sant'Andrea Hospital, Via di Grottarossa 1035, 00189 Rome, Italy
| | - Juliana Fortes Lindau
- Neurosciences, Mental Health and Sensory Functions (NESMOS) Department, Sapienza University of Rome, Faculty of Medicine and Psychology, Sant'Andrea Hospital, Via di Grottarossa 1035, 00189 Rome, Italy
| | - Andrea Solfanelli
- Neurosciences, Mental Health and Sensory Functions (NESMOS) Department, Sapienza University of Rome, Faculty of Medicine and Psychology, Sant'Andrea Hospital, Via di Grottarossa 1035, 00189 Rome, Italy
| | - Giulia Listanti
- Department of Neurology and Psychiatry, Sapienza University of Rome, Faculty of Medicine and Odontology, Rome 00156, Italy
| | - Martina Patanè
- Department of Neurology and Psychiatry, Sapienza University of Rome, Faculty of Medicine and Odontology, Rome 00156, Italy
| | - Giorgio Kotzalidis
- Neurosciences, Mental Health and Sensory Functions (NESMOS) Department, Sapienza University of Rome, Faculty of Medicine and Psychology, Sant'Andrea Hospital, Via di Grottarossa 1035, 00189 Rome, Italy
| | - Eva Gebhardt
- Neurosciences, Mental Health and Sensory Functions (NESMOS) Department, Sapienza University of Rome, Faculty of Medicine and Psychology, Sant'Andrea Hospital, Via di Grottarossa 1035, 00189 Rome, Italy
| | - Nicholas Meyer
- Institute of Psychiatry, King's College, 16 De Crespigny Park, SE5 8AF London, United Kingdom
| | - Diana Di Pietro
- Community Mental Health Service, ASL Rome H, 00041 Rome, Italy
| | - Donato Leccisi
- Community Mental Health Service, ASL Rome H, 00041 Rome, Italy
| | - Paolo Girardi
- Neurosciences, Mental Health and Sensory Functions (NESMOS) Department, Sapienza University of Rome, Faculty of Medicine and Psychology, Sant'Andrea Hospital, Via di Grottarossa 1035, 00189 Rome, Italy
| | - Paolo Fiori Nastro
- Department of Neurology and Psychiatry, Sapienza University of Rome, Faculty of Medicine and Odontology, Rome 00156, Italy
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Schultze-Lutter F, Michel C, Ruhrmann S, Schimmelmann BG. Prevalence and clinical significance of DSM-5-attenuated psychosis syndrome in adolescents and young adults in the general population: the Bern Epidemiological At-Risk (BEAR) study. Schizophr Bull 2014; 40:1499-508. [PMID: 24353096 PMCID: PMC4193691 DOI: 10.1093/schbul/sbt171] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Section III of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) lists attenuated psychosis syndrome as a condition for further study. One important question is its prevalence and clinical significance in the general population. METHOD Analyses involved 1229 participants (age 16-40 years) from the general population of Canton Bern, Switzerland, enrolled from June 2011 to July 2012. "Symptom," "onset/worsening," "frequency," and "distress/disability" criteria of attenuated psychosis syndrome were assessed using the structured interview for psychosis-risk syndromes. Furthermore, help-seeking, psychosocial functioning, and current nonpsychotic axis I disorders were surveyed. Well-trained psychologists performed assessments using the computer-assisted telephone interviewing technique. RESULTS The symptom criterion was met by 12.9% of participants, onset/worsening by 1.1%, frequency by 3.8%, and distress/disability by 7.0%. Symptom, frequency, and distress/disability were met by 3.2%. Excluding trait-like attenuated psychotic symptoms (APS) decreased the prevalence to 2.6%, while adding onset/worsening reduced it to 0.3%. APS were associated with functional impairments, current mental disorders, and help-seeking although they were not a reason for help-seeking. These associations were weaker for attenuated psychosis syndrome. CONCLUSIONS At the population level, only 0.3% met current attenuated psychosis syndrome criteria. Particularly, the onset/worsening criterion, originally included to increase the likelihood of progression to psychosis, lowered its prevalence. Because progression is not required for a self-contained syndrome, a revision of the restrictive onset criterion is proposed to avoid the exclusion of 2.3% of persons who experience and are distressed by APS from mental health care. Secondary analyses suggest that a revised syndrome would also possess higher clinical significance than the current syndrome.
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Affiliation(s)
- Frauke Schultze-Lutter
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; and
| | - Chantal Michel
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; and
| | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - Benno G Schimmelmann
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; and
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Patterns and correlates of expressed emotion, perceived criticism, and rearing style in first admitted early-onset schizophrenia spectrum disorders. J Nerv Ment Dis 2014; 202:783-7. [PMID: 25259947 DOI: 10.1097/nmd.0000000000000209] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The aim of this study was to assess patterns and correlates of family variables in 31 adolescents treated for their first episode of a schizophrenia spectrum disorder (early-onset schizophrenia [EOS]). Expressed emotion, perceived criticism, and rearing style were assessed. Potential correlates were patient psychopathology, premorbid adjustment, illness duration, quality of life (QoL), sociodemographic variables, patient and caregiver "illness concept," and caregiver personality traits and support. Families were rated as critical more frequently by patients than raters (55% vs. 13%). Perceived criticism was associated with worse QoL in relationship with parents and peers. An adverse rearing style was associated with a negative illness concept in patients, particularly with less trust in their physician. Future research should examine perceived criticism as a predictor of relapse and indicator of adolescents with EOS who need extended support and treatment. Rearing style should be carefully observed because of its link with patients' illness concept and, potentially, to service engagement and medication adherence.
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Ruhrmann S, Schultze-Lutter F, Schmidt SJ, Kaiser N, Klosterkötter J. Prediction and prevention of psychosis: current progress and future tasks. Eur Arch Psychiatry Clin Neurosci 2014; 264 Suppl 1:S9-16. [PMID: 25256263 DOI: 10.1007/s00406-014-0541-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 09/06/2014] [Indexed: 12/28/2022]
Abstract
Prevention of psychoses has been intensively investigated within the past two decades, and particularly, prediction has been much advanced. Depending on the applied risk indicators, current criteria are associated with average, yet significantly heterogeneous transition rates of ≥30 % within 3 years, further increasing with longer follow-up periods. Risk stratification offers a promising approach to advance current prediction as it can help to reduce heterogeneity of transition rates and to identify subgroups with specific needs and response patterns, enabling a targeted intervention. It may also be suitable to improve risk enrichment. Current results suggest the future implementation of multi-step risk algorithms combining sensitive risk detection by cognitive basic symptoms (COGDIS) and ultra-high-risk (UHR) criteria with additional individual risk estimation by a prognostic index that relies on further predictors such as additional clinical indicators, functional impairment, neurocognitive deficits, and EEG and structural MRI abnormalities, but also considers resilience factors. Simply combining COGDIS and UHR criteria in a second step of risk stratification produced already a 4-year hazard rate of 0.66. With regard to prevention, two recent meta-analyses demonstrated that preventive measures enable a reduction in 12-month transition rates by 54-56 % with most favorable numbers needed to treat of 9-10. Unfortunately, psychosocial functioning, another important target of preventive efforts, did not improve. However, these results are based on a relatively small number of trials; and more methodologically sound studies and a stronger consideration of individual profiles of clinical needs by modular intervention programs are required.
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Affiliation(s)
- Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, University of Cologne, Kerpener Strasse 62, 50924, Cologne, Germany,
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50
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Calkins ME, Moore TM, Merikangas KR, Burstein M, Satterthwaite TD, Bilker WB, Ruparel K, Chiavacci R, Wolf DH, Mentch F, Qiu H, Connolly JJ, Sleiman PA, Hakonarson H, Gur RC, Gur RE. The psychosis spectrum in a young U.S. community sample: findings from the Philadelphia Neurodevelopmental Cohort. World Psychiatry 2014; 13:296-305. [PMID: 25273303 PMCID: PMC4219071 DOI: 10.1002/wps.20152] [Citation(s) in RCA: 144] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Little is known about the occurrence and predictors of the psychosis spectrum in large non-clinical community samples of U.S. youths. We aimed to bridge this gap through assessment of psychosis spectrum symptoms in the Philadelphia Neurodevelopmental Cohort, a collaborative investigation of clinical and neurobehavioral phenotypes in a prospectively accrued cohort of youths, funded by the National Institute of Mental Health. Youths (age 11-21; N=7,054) and collateral informants (caregiver/legal guardian) were recruited through the Children's Hospital of Philadelphia and administered structured screens of psychosis spectrum symptoms, other major psychopathology domains, and substance use. Youths were also administered a computerized neurocognitive battery assessing five neurobehavioral domains. Predictors of psychosis spectrum status in physically healthy participants (N=4,848) were examined using logistic regression. Among medically healthy youths, 3.7% reported threshold psychotic symptoms (delusions and/or hallucinations). An additional 12.3% reported significant sub-psychotic positive symptoms, with odd/unusual thoughts and auditory perceptions, followed by reality confusion, being the most discriminating and widely endorsed attenuated symptoms. A minority of youths (2.3%) endorsed subclinical negative/disorganized symptoms in the absence of positive symptoms. Caregivers reported lower symptom levels than their children. Male gender, younger age, and non-European American ethnicity were significant predictors of spectrum status. Youths with spectrum symptoms had reduced accuracy across neurocognitive domains, reduced global functioning, and increased odds of depression, anxiety, behavioral disorders, substance use and suicidal ideation. These findings have public health relevance for prevention and early intervention.
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Affiliation(s)
- Monica E Calkins
- Department of Psychiatry, Neuropsychiatry Section, Perelman School of Medicine, University of Pennsylvania9 Maloney, 3600 Spruce Street, Philadelphia, PA, 19104, USA
| | - Tyler M Moore
- Department of Psychiatry, Neuropsychiatry Section, Perelman School of Medicine, University of Pennsylvania9 Maloney, 3600 Spruce Street, Philadelphia, PA, 19104, USA
| | - Kathleen R Merikangas
- Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental HealthBethesda, MD, USA
| | - Marcy Burstein
- Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental HealthBethesda, MD, USA
| | - Theodore D Satterthwaite
- Department of Psychiatry, Neuropsychiatry Section, Perelman School of Medicine, University of Pennsylvania9 Maloney, 3600 Spruce Street, Philadelphia, PA, 19104, USA
| | - Warren B Bilker
- Department of Psychiatry, Neuropsychiatry Section, Perelman School of Medicine, University of Pennsylvania9 Maloney, 3600 Spruce Street, Philadelphia, PA, 19104, USA
| | - Kosha Ruparel
- Department of Psychiatry, Neuropsychiatry Section, Perelman School of Medicine, University of Pennsylvania9 Maloney, 3600 Spruce Street, Philadelphia, PA, 19104, USA
| | - Rosetta Chiavacci
- Center for Applied Genomics at the Children's Hospital of PhiladelphiaPhiladelphia, PA, USA
| | - Daniel H Wolf
- Department of Psychiatry, Neuropsychiatry Section, Perelman School of Medicine, University of Pennsylvania9 Maloney, 3600 Spruce Street, Philadelphia, PA, 19104, USA
| | - Frank Mentch
- Center for Applied Genomics at the Children's Hospital of PhiladelphiaPhiladelphia, PA, USA
| | - Haijun Qiu
- Center for Applied Genomics at the Children's Hospital of PhiladelphiaPhiladelphia, PA, USA
| | - John J Connolly
- Center for Applied Genomics at the Children's Hospital of PhiladelphiaPhiladelphia, PA, USA
| | - Patrick A Sleiman
- Center for Applied Genomics at the Children's Hospital of PhiladelphiaPhiladelphia, PA, USA,Department of Pediatrics, Perelman School of Medicine, University of PhiladelphiaPhiladelphia, PA, USA
| | - Hakon Hakonarson
- Center for Applied Genomics at the Children's Hospital of PhiladelphiaPhiladelphia, PA, USA,Department of Pediatrics, Perelman School of Medicine, University of PhiladelphiaPhiladelphia, PA, USA
| | - Ruben C Gur
- Department of Psychiatry, Neuropsychiatry Section, Perelman School of Medicine, University of Pennsylvania9 Maloney, 3600 Spruce Street, Philadelphia, PA, 19104, USA
| | - Raquel E Gur
- Department of Psychiatry, Neuropsychiatry Section, Perelman School of Medicine, University of Pennsylvania9 Maloney, 3600 Spruce Street, Philadelphia, PA, 19104, USA
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