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McCarthy JM, Carol EE, Fedele SJ, Shinners MG, Walia H, Yelick J, Öngür D. Creation of a Psychotic Disorders Research Advisory Board as a Shared Resource. Psychiatr Serv 2024; 75:387-390. [PMID: 38204370 PMCID: PMC10984771 DOI: 10.1176/appi.ps.20230328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
Community engagement is important for research, yet many researchers do not routinely seek feedback from people with lived experience. A key barrier to this engagement is that the resources required to create an advisory board may be unavailable to individual investigators, and creating an advisory board for a single study may often be impractical. In this column, the authors describe how to create a standing research advisory board that can serve as a shared resource for researchers and community members and provide a psychosis research advisory board example to aid discussion.
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Affiliation(s)
- Julie M. McCarthy
- Division of Psychotic Disorders, McLean Hospital, Belmont, MA
- Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Emily E. Carol
- Division of Psychotic Disorders, McLean Hospital, Belmont, MA
- Department of Psychiatry, Harvard Medical School, Boston, MA
| | | | | | - Hadley Walia
- Division of Psychotic Disorders, McLean Hospital, Belmont, MA
| | - Julia Yelick
- Graduate School of Biomedical Sciences, Tufts University, Boston, MA
| | - Dost Öngür
- Division of Psychotic Disorders, McLean Hospital, Belmont, MA
- Department of Psychiatry, Harvard Medical School, Boston, MA
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McCarthy JM, Hudson JI, Carol EE, Kuller AM, Ramadurai R, Björgvinsson T, Beard C. Readiness for treatment predicts depression outcomes in a partial hospital program. Psychol Serv 2024:2024-42919-001. [PMID: 38206859 DOI: 10.1037/ser0000835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
Evidence-based interventions vary in effectiveness for individuals with depression, which has a large public health burden. Readiness for change or treatment can be an important individual difference predictor of depression outcomes. To inform public service initiatives targeting readiness for treatment, characterizing readiness across settings and levels of care is key. However, limited data exist on the role of readiness for treatment in acute psychiatric settings and in particular, partial hospital programs which are key points in the continuity of inpatient and outpatient care. The present study assessed readiness for treatment in terms of importance, confidence, and motivation to engage in a partial hospital program and tested whether higher levels of readiness were associated with better treatment outcomes among clients with depression. Participants (N = 192) with major depressive disorder rated their readiness for treatment (Readiness Rulers), depression (Patient Health Questionnaire-9), and global improvement (Clinical Global Impression Scale-Improvement Self-Report) while enrolled in a partial hospital program. Generalized linear regression models assessed the effect of baseline readiness on outcomes at discharge, adjusted for baseline level of the outcome, age, sex, race, and ethnicity. Greater baseline readiness predicted reduced depression and better global improvement at discharge. Higher confidence and motivation to engage in treatment, but not importance, were associated with better depression outcomes. Identifying and addressing readiness for treatment by leveraging public health systems and services (e.g., help lines, family interventions) prior to or upon starting a partial hospital program may be useful to maximize gains in treatment. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Gupta T, Horton WS, Haase CM, Carol EE, Mittal VA. Clues from caregiver emotional language usage highlight the link between putative social environment and the psychosis-risk syndrome. Schizophr Res 2023; 259:4-10. [PMID: 35400558 PMCID: PMC9578001 DOI: 10.1016/j.schres.2022.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 03/23/2022] [Accepted: 03/24/2022] [Indexed: 10/18/2022]
Abstract
Familial emotional word usage has long been implicated in symptom progression in schizophrenia. However, few studies have examined caregiver emotional word usage prior to the onset of psychosis, among those with a clinical high-risk (CHR) syndrome. The current study examined emotional word usage in a sample of caregivers of CHR individuals (N = 37) and caregivers of healthy controls (N = 40) and links with clinical symptoms in CHR individuals. Caregivers completed a speech sample task in which they were asked to speak about the participant; speech samples were then transcribed and analyzed for general positive (e.g. good) and negative (e.g., worthless) emotional words as well as words expressing three specific negative emotions (i.e., anxiety, anger, and sadness) using Linguistic Inquiry and Word Count (LIWC). Findings indicated that (1) CHR caregivers used more negative and anxiety words compared to control caregivers; and (2) less positive word usage among CHR caregivers were related to more positive symptomatology among CHR individuals. These findings point toward the utility of automated language analysis in assessing the intersections between caregiver emotional language use and psychopathology.
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Affiliation(s)
- Tina Gupta
- Department of Psychology, Northwestern University, Evanston, IL, USA.
| | - William S Horton
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - Claudia M Haase
- Department of Psychology, Northwestern University, Evanston, IL, USA; School of Education and Social Policy, Northwestern University, Evanston, IL, USA
| | - Emily E Carol
- Psychotic Disorders Division, McLean Hospital/Harvard Medical School, Belmont, MA, USA
| | - Vijay A Mittal
- Department of Psychology, Northwestern University, Evanston, IL, USA
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McCarthy JM, Wood AJ, Shinners MG, Heinrich H, Weiss RD, Mueser KT, Meyers RJ, Carol EE, Hudson JI, Öngür D. Pilot development and feasibility of telehealth Community Reinforcement and Family Training (CRAFT) for early psychosis and substance use. Psychiatry Res 2022; 317:114804. [PMID: 36030701 PMCID: PMC10127150 DOI: 10.1016/j.psychres.2022.114804] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 08/17/2022] [Accepted: 08/18/2022] [Indexed: 10/31/2022]
Abstract
Substance use is associated with poor outcomes for individuals with early psychosis. Community Reinforcement and Family Training (CRAFT) is an evidence-based approach that helps families to reduce substance use, engage in treatment, and improve family wellbeing, but it has not yet been studied for psychosis and substance use. The present study aimed to develop and evaluate a telehealth intervention utilizing CRAFT for families experiencing early psychosis and substance use. Twenty family members completed six to eight telehealth sessions of CRAFT adapted for early psychosis (CRAFT-EP). Participants completed an assessment battery at baseline, mid- and post-intervention, a three-month follow-up, surveys after each session, and a focus group to measure mean percentage of sessions completed, mean program satisfaction ratings, telehealth preference, and qualitative feedback. Participants had 100% session completion, and program satisfaction was at or near excellent for 99% of sessions. Half of participants preferred a primarily virtual hybrid program, whereas 45% preferred exclusively virtual visits. Communication was the most helpful topic, and participants requested additional written examples and resources. CRAFT-EP is feasible and acceptable to serve as the active intervention in a pilot randomized controlled trial comparing treatment as usual plus CRAFT-EP to treatment as usual.
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Affiliation(s)
- Julie M McCarthy
- Division of Psychotic Disorders, McLean Hospital, 115 Mill St., Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - Andrea J Wood
- Division of Psychotic Disorders, McLean Hospital, 115 Mill St., Belmont, MA 02478, USA
| | - M Grace Shinners
- Division of Psychotic Disorders, McLean Hospital, 115 Mill St., Belmont, MA 02478, USA
| | - Hadley Heinrich
- Division of Psychotic Disorders, McLean Hospital, 115 Mill St., Belmont, MA 02478, USA
| | - Roger D Weiss
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Division of Alcohol, Drugs, and Addiction, McLean Hospital, Belmont, MA, USA
| | - Kim T Mueser
- Center for Psychiatric Rehabilitation, Departments of Occupational Therapy and Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Robert J Meyers
- Center on Alcoholism, Substance Abuse and Addiction, University of New, Albuquerque, NM, USA
| | - Emily E Carol
- Division of Psychotic Disorders, McLean Hospital, 115 Mill St., Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - James I Hudson
- Division of Psychotic Disorders, McLean Hospital, 115 Mill St., Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Dost Öngür
- Division of Psychotic Disorders, McLean Hospital, 115 Mill St., Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Millman ZB, Guvenek-Cokol PE, Kim HJ, Öngür D, Carol EE. The support, treatment, and resilience (STAR) program for youth at clinical high-risk of psychosis. Schizophr Res 2022; 248:122-123. [PMID: 36037644 DOI: 10.1016/j.schres.2022.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/15/2022] [Accepted: 08/20/2022] [Indexed: 11/24/2022]
Affiliation(s)
- Zachary B Millman
- Psychotic Disorders Division, McLean Hospital, 115 Mill Street, Belmont, MA 02478, United States of America; Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA 02114, United States of America.
| | - P Esra Guvenek-Cokol
- Psychotic Disorders Division, McLean Hospital, 115 Mill Street, Belmont, MA 02478, United States of America; Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA 02114, United States of America
| | - Hyun Jung Kim
- Psychotic Disorders Division, McLean Hospital, 115 Mill Street, Belmont, MA 02478, United States of America; Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA 02114, United States of America
| | - Dost Öngür
- Psychotic Disorders Division, McLean Hospital, 115 Mill Street, Belmont, MA 02478, United States of America; Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA 02114, United States of America
| | - Emily E Carol
- Psychotic Disorders Division, McLean Hospital, 115 Mill Street, Belmont, MA 02478, United States of America; Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA 02114, United States of America
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Szmulewicz A, Öngür D, Shinn AK, Carol EE, Dow J, Yilmaz N, Durning PT, Sastry JM, Hsu J. Impact of the COVID-19 Pandemic on the Employment and Educational Outcomes of Individuals in a First-Episode Psychosis Clinic. Psychiatr Serv 2022; 73:165-171. [PMID: 34189932 DOI: 10.1176/appi.ps.202100114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE A central objective of early psychosis therapy is to restore social functioning (e.g., through employment and education). Employment and educational outcomes during the COVID-19 pandemic were examined in a well-defined cohort of patients receiving care in an early psychosis clinic. METHODS Data were extracted from the electronic health records of 128 patients receiving care at McLean Hospital's first-episode psychosis (FEP) clinic between January 1 and September 21 in 2019 and 2020. Using a generalized linear model with a Gaussian distribution and robust standard errors, the authors compared the average changes in the weekly employment and education proportions before and after COVID-19 lockdowns with the same changes in 2019. RESULTS Employment losses among patients with FEP were greater than among the general population and persisted through the end of follow-up. In 2020, average employment after a stay-at-home order was instituted was 33% lower than before the order compared with the change in employment during the same period in 2019. The effect was stronger among men and those who identified as non-White, were age <21 years, or did not have a college education. Although educational engagement recovered in the fall of 2020, it still remained below the 2019 levels. CONCLUSIONS Employment disruptions were major and persistent among the FEP population, which might affect short- and long-term outcomes. Innovative approaches are needed to help patients transition to remote employment, file unemployment claims, and use online hiring platforms to ameliorate the indirect effects of the COVID-19 pandemic.
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Affiliation(s)
- Alejandro Szmulewicz
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston (Szmulewicz); Psychotic Disorders Division, McLean Hospital, Belmont, Massachusetts (Öngür, Shinn, Carol, Dow, Yilmaz, Durning); Department of Psychiatry (Öngür, Shinn, Carol) and Department of Health Care Policy (Hsu), Harvard Medical School, Boston; Mongan Institute, Massachusetts General Hospital, Boston (Sastry, Hsu)
| | - Dost Öngür
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston (Szmulewicz); Psychotic Disorders Division, McLean Hospital, Belmont, Massachusetts (Öngür, Shinn, Carol, Dow, Yilmaz, Durning); Department of Psychiatry (Öngür, Shinn, Carol) and Department of Health Care Policy (Hsu), Harvard Medical School, Boston; Mongan Institute, Massachusetts General Hospital, Boston (Sastry, Hsu)
| | - Ann K Shinn
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston (Szmulewicz); Psychotic Disorders Division, McLean Hospital, Belmont, Massachusetts (Öngür, Shinn, Carol, Dow, Yilmaz, Durning); Department of Psychiatry (Öngür, Shinn, Carol) and Department of Health Care Policy (Hsu), Harvard Medical School, Boston; Mongan Institute, Massachusetts General Hospital, Boston (Sastry, Hsu)
| | - Emily E Carol
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston (Szmulewicz); Psychotic Disorders Division, McLean Hospital, Belmont, Massachusetts (Öngür, Shinn, Carol, Dow, Yilmaz, Durning); Department of Psychiatry (Öngür, Shinn, Carol) and Department of Health Care Policy (Hsu), Harvard Medical School, Boston; Mongan Institute, Massachusetts General Hospital, Boston (Sastry, Hsu)
| | - Jacqueline Dow
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston (Szmulewicz); Psychotic Disorders Division, McLean Hospital, Belmont, Massachusetts (Öngür, Shinn, Carol, Dow, Yilmaz, Durning); Department of Psychiatry (Öngür, Shinn, Carol) and Department of Health Care Policy (Hsu), Harvard Medical School, Boston; Mongan Institute, Massachusetts General Hospital, Boston (Sastry, Hsu)
| | - Nergiz Yilmaz
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston (Szmulewicz); Psychotic Disorders Division, McLean Hospital, Belmont, Massachusetts (Öngür, Shinn, Carol, Dow, Yilmaz, Durning); Department of Psychiatry (Öngür, Shinn, Carol) and Department of Health Care Policy (Hsu), Harvard Medical School, Boston; Mongan Institute, Massachusetts General Hospital, Boston (Sastry, Hsu)
| | - Peter T Durning
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston (Szmulewicz); Psychotic Disorders Division, McLean Hospital, Belmont, Massachusetts (Öngür, Shinn, Carol, Dow, Yilmaz, Durning); Department of Psychiatry (Öngür, Shinn, Carol) and Department of Health Care Policy (Hsu), Harvard Medical School, Boston; Mongan Institute, Massachusetts General Hospital, Boston (Sastry, Hsu)
| | - Jayram M Sastry
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston (Szmulewicz); Psychotic Disorders Division, McLean Hospital, Belmont, Massachusetts (Öngür, Shinn, Carol, Dow, Yilmaz, Durning); Department of Psychiatry (Öngür, Shinn, Carol) and Department of Health Care Policy (Hsu), Harvard Medical School, Boston; Mongan Institute, Massachusetts General Hospital, Boston (Sastry, Hsu)
| | - John Hsu
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston (Szmulewicz); Psychotic Disorders Division, McLean Hospital, Belmont, Massachusetts (Öngür, Shinn, Carol, Dow, Yilmaz, Durning); Department of Psychiatry (Öngür, Shinn, Carol) and Department of Health Care Policy (Hsu), Harvard Medical School, Boston; Mongan Institute, Massachusetts General Hospital, Boston (Sastry, Hsu)
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Carol EE, Spencer RL, Mittal VA. Acute Physiological and Psychological Stress Response in Youth at Clinical High-Risk for Psychosis. Front Psychiatry 2021; 12:641762. [PMID: 33679489 PMCID: PMC7933586 DOI: 10.3389/fpsyt.2021.641762] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/01/2021] [Indexed: 12/19/2022] Open
Abstract
Deficits in stress-response systems are a characteristic of schizophrenia and psychosis spectrum illnesses, and recent evidence suggests that this impairment may be evident in those at clinical high-risk (CHR) for the development of a psychotic disorder. However, there is limited research specifically investigating biological and subjective stress reactivity in CHR individuals. In the present study, 38 CHR individuals and group of 38 control individuals participated in the Trier Social Stress Test (TSST), an experimentally induced psychosocial stressor. Changes in salivary cortisol and alpha amylase, as well as self-reported units of distress (SUDS), were evaluated. Interestingly, the TSST did not induce a change in cortisol levels in either group, though the CHR group did show higher overall cortisol levels throughout the TSST (pre-anticipation period through recovery period). However, indicative of an effective task manipulation, the TSST did illicit an increase in alpha amylase in both groups. CHR participants exhibited higher levels of subjective stress prior to the stressor compared to the control group and CHR SUDs did not significantly increase in response to the stressor. In contrast, the control group showed an increase in SUDS in response to the stressor. Notably, SUDS for the control group post task mirrored the levels CHR youth endorsed prior to the stressor. Taken together, these findings suggest that there may be a functional relationship between persistently elevated cortisol and chronic high levels of subjective distress in CHR individuals.
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Affiliation(s)
- Emily E Carol
- Laboratory for Early Psychosis (LEAP) Center, Psychotic Disorders Division, McLean Hospital and Harvard Medical School, Belmont, MA, United States
| | - Robert L Spencer
- Spener Neuroendocrinology Laboratory, Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, United States
| | - Vijay A Mittal
- Adolescent Development and Preventative Treatment Program, Departments of Psychology, Psychiatry, and Medical Social Sciences, Institute for Policy Research, Northwestern University, Evanston, IL, United States
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Carol EE, Mittal VA. Corrigendum to "self-reported cannabis use is inconsistent with the results from drug-screening in youth at ultra high-risk for psychosis in Colorado" [Schizophr. Res. 157 (0) (August 2014) 317-318]. Schizophr Res 2018; 192:494. [PMID: 28476338 DOI: 10.1016/j.schres.2017.04.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 04/22/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Emily E Carol
- University of Colorado Boulder, Department of Psychology and Neuroscience, United States; University of Colorado Boulder, Center for Neuroscience, United States.
| | - Vijay A Mittal
- University of Colorado Boulder, Department of Psychology and Neuroscience, United States; University of Colorado Boulder, Center for Neuroscience, United States
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Carol EE, Spencer RL, Mittal VA. Sex differences in morning cortisol in youth at ultra-high-risk for psychosis. Psychoneuroendocrinology 2016; 72:87-93. [PMID: 27388688 PMCID: PMC4996727 DOI: 10.1016/j.psyneuen.2016.06.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 06/14/2016] [Accepted: 06/20/2016] [Indexed: 12/23/2022]
Abstract
Research suggests abnormalities in hypothalamic-pituitary-adrenal (HPA) axis function play an important role in the pathophysiology of psychosis. However, there is limited research on the biological stress system in young people at ultra high risk (UHR) for psychosis. Morning cortisol levels are particularly relevant to study in this context, as these markers reflect HPA regulation. This is the first examination of sex differences in morning cortisol levels in UHR individuals. Twenty-eight UHR and 22 matched healthy control participants were assessed in respect to symptoms and had home-based collection of salivary cortisol over three time points in the morning. It was predicted that the UHR participants would exhibit lower morning cortisol levels and lower cortisol would be associated with greater symptomatology (i.e. higher positive, negative, and depressive symptoms). Additionally, sex differences in morning cortisol levels were explored based on recent evidence suggesting that sex differences may play an important role in the exacerbation of psychosis. While there were no group differences in morning salivary cortisol secretion, there was a sex by time interaction among UHR individuals, such that only UHR males exhibited flat cortisol levels across two hours after awakening, whereas UHR females had a pattern of cortisol secretion similar to healthy controls, even among medication-free individuals (F=6.34, p=0.004). Cortisol AUC (area under the curve) across the three time points had a trend association (medium effect size; r=0.34, p=0.08) with depressive, but not positive or negative, symptom severity. These results stress the importance of considering sex differences in the psychosis-risk period, as they improve understanding of pathogenic processes.
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Affiliation(s)
- Emily E Carol
- University of Colorado Boulder, Department of Psychology and Neuroscience, Boulder, CO, 80309, United States; University of Colorado Boulder, Center for Neuroscience, Boulder, CO, 80309, United States.
| | - Robert L Spencer
- University of Colorado Boulder, Department of Psychology and Neuroscience, Boulder, CO, 80309, United States; University of Colorado Boulder, Center for Neuroscience, Boulder, CO, 80309, United States
| | - Vijay A Mittal
- Northwestern University, Department for Psychology, Evanston, Illinois, 60208, United States; Northwestern University, Department for Psychiatry, Chicago, Illinois, 60611, United States
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Dean DJ, Orr JM, Bernard JA, Gupta T, Pelletier-Baldelli A, Carol EE, Mittal VA. Hippocampal Shape Abnormalities Predict Symptom Progression in Neuroleptic-Free Youth at Ultrahigh Risk for Psychosis. Schizophr Bull 2016; 42:161-9. [PMID: 26113620 PMCID: PMC4681548 DOI: 10.1093/schbul/sbv086] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Hippocampal abnormalities have been widely studied in schizophrenia spectrum populations including those at ultrahigh risk (UHR) for psychosis. There have been inconsistent findings concerning hippocampal morphology prior to and during the transition to psychosis, and little is known about how specific subregions are related to the symptom progression. METHODS A total of 80 participants (38 UHR and 42 healthy controls) underwent a 3T MRI scan, as well as structured clinical interviews. Shape analysis of hippocampi was conducted with FSL/FIRST vertex analysis to yield a localized measure of shape differences between groups. A subgroup of the sample (24 UHR and 24 controls) also returned for a 12-month clinical follow-up assessment. RESULTS The UHR group exhibited smaller hippocampal volumes bilaterally, and shape analysis revealed significant inversion in the left ventral posterior hippocampus in the UHR group. Greater inversion in this subregion was related to elevated symptomatology at baseline and increased positive symptoms, negative symptoms, and impaired tolerance to normal stress 12 months later. These results did not hold when left hippocampal volume was used as a predictor instead. DISCUSSION This represents the first study to use vertex analysis in a UHR sample and results suggest that abnormalities in hippocampal shape appear to reflect underlying pathogenic processes driving the progression of illness. These findings suggest that examining shape and volume may provide an important new perspective for our conception of brain alterations in the UHR period.
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Affiliation(s)
- Derek J. Dean
- Department of Psychology and Neuroscience,,Center for Neuroscience, and,*To whom correspondence should be addressed; Department of Psychology and Neuroscience, Center for Neuroscience, University of Colorado Boulder 345 UCB Boulder, CO 80309–0345, US; tel: 303-492-4616, fax: 303-492-5737, e-mail:
| | - Joseph M. Orr
- Institute for Cognitive Science, University of Colorado Boulder, Boulder, CO
| | | | - Tina Gupta
- Department of Psychology and Neuroscience
| | | | | | - Vijay A. Mittal
- Department of Psychology, Northwestern University, Evanston, IL
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Carol EE, Mittal VA. Normative adolescent experiences may confound assessment of positive symptoms in youth at ultra-high risk for psychosis. Schizophr Res 2015; 166:358-9. [PMID: 25986415 DOI: 10.1016/j.schres.2015.04.043] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 04/29/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Emily E Carol
- University of Colorado Boulder, Department of Psychology and Neuroscience, United States; Northwestern University, Department of Psychology, Evanston, IL, 60208, USA.
| | - Vijay A Mittal
- University of Colorado Boulder, Department of Psychology and Neuroscience, United States; Northwestern University, Department of Psychology, Evanston, IL, 60208, USA
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Carol EE, Mittal VA. Resting cortisol level, self-concept, and putative familial environment in adolescents at ultra high-risk for psychotic disorders. Psychoneuroendocrinology 2015; 57:26-36. [PMID: 25880698 PMCID: PMC4437835 DOI: 10.1016/j.psyneuen.2015.03.018] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 03/20/2015] [Accepted: 03/21/2015] [Indexed: 12/24/2022]
Abstract
A growing body of evidence suggests that resting cortisol levels are elevated in patients with schizophrenia and closely tied to symptom severity. However, there is limited research on the biological stress system during the ultra high-risk (UHR) period immediately preceding the onset of psychosis, and cortisol has not been examined in relation to individual characteristics such as self-concept or potential stressors such as putative familial environment in this critical population. In the present study, salivary cortisol samples were collected on 37 UHR and 42 matched control adolescents, and these individuals were assessed with clinical interviews as well as a measure of self-concept. For a subsection of the sample (23 UHR and 20 control adolescents), a participating relative/caretaker was also assessed with an expressed emotion interview designed to gauge psychosocial environment. Consistent with previous studies, UHR participants exhibited elevated resting cortisol levels when compared with controls. In addition, UHR adolescents exhibited increased negative self-concept and their relatives/caretakers endorsed significantly fewer initial positive statements about the participant. Interestingly, a strong trend in the UHR group suggests that higher cortisol levels are associated with higher rates of critical statements from relatives/caretakers. Furthermore, elevated cortisol levels in the participants were associated with increased negative self-concept as well as fewer initial positive comments from relatives/caretakers. Results suggest that hypothalamic-pituitary-adrenal axis (HPA) dysfunction is closely associated with both individual and environmental-level characteristics. Taken together, these findings support a neural diathesis-stress model of psychosis and future studies, designed to examine causal relationships, stand to inform both our understanding of pathogenic processes in the high-risk period as well as early intervention efforts.
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Affiliation(s)
- Emily E. Carol
- University of Colorado Boulder Department of Psychology and Neuroscience Boulder, Colorado, 80309 United States of America,Corresponding Author: Emily E. Carol University of Colorado at Boulder Department of Psychology and Neuroscience, Center for Neuroscience 345 UCB Boulder, CO 80309-0345 Phone: 303.492-4616
| | - Vijay A. Mittal
- Northwestern University, Department of Psychology, Evanston, IL, 60208, USA
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Dean DJ, Kent JS, Bernard JA, Orr JM, Gupta T, Pelletier-Baldelli A, Carol EE, Mittal VA. Increased postural sway predicts negative symptom progression in youth at ultrahigh risk for psychosis. Schizophr Res 2015; 162:86-9. [PMID: 25601361 PMCID: PMC4339540 DOI: 10.1016/j.schres.2014.12.039] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 12/22/2014] [Accepted: 12/29/2014] [Indexed: 12/29/2022]
Abstract
Impaired ability to maintain an upright posture may reflect impairment in the cerebellum, a critical structure for the fluid coordination of neural information, thought to be disrupted in psychosis. The current study utilized an instrumental measure of posture in individuals at ultrahigh risk (UHR) for psychosis (n=43) and healthy controls (n=44). Positive and negative symptoms were assessed twice over 12months. Results showed that increased postural sway in the UHR group predicted changes in negative symptoms. This study provides an important prospective view on the relationship between cerebellar-sensitive behavior and integral symptoms, which until now has received limited biomarker research.
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Affiliation(s)
- Derek J. Dean
- University of Colorado Boulder, Department of Psychology and Neuroscience,University of Colorado, Boulder Center for Neuroscience,Corresponding Author: Derek J. Dean, University of Colorado at Boulder, Department of Psychology and Neuroscience, Center for Neuroscience, 345 UCB, Boulder, CO 80309-0345, , Phone: 303-492-4616
| | - Jerillyn S. Kent
- Indiana University, Department of Psychological and Brain Sciences,Minneapolis VA Health Care System
| | - Jessica A. Bernard
- University of Colorado Boulder, Department of Psychology and Neuroscience
| | - Joseph M. Orr
- University of Colorado Boulder, Institute for Cognitive Science
| | - Tina Gupta
- University of Colorado Boulder, Department of Psychology and Neuroscience
| | - Andrea Pelletier-Baldelli
- University of Colorado Boulder, Department of Psychology and Neuroscience,University of Colorado, Boulder Center for Neuroscience
| | - Emily E. Carol
- University of Colorado Boulder, Department of Psychology and Neuroscience
| | - Vijay A. Mittal
- University of Colorado Boulder, Department of Psychology and Neuroscience,University of Colorado, Boulder Center for Neuroscience
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15
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Mittal VA, Dean DJ, Bernard JA, Orr JM, Pelletier-Baldelli A, Carol EE, Gupta T, Turner J, Leopold DR, Robustelli BL, Millman ZB. Neurological soft signs predict abnormal cerebellar-thalamic tract development and negative symptoms in adolescents at high risk for psychosis: a longitudinal perspective. Schizophr Bull 2014; 40:1204-15. [PMID: 24375457 PMCID: PMC4193696 DOI: 10.1093/schbul/sbt199] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
INTRODUCTION There is an emerging consensus that neurological soft signs (NSS) may not be "soft" at all but rather may reflect neuropathy, particularly in the cerebellum and thalamus. However, our understanding of connective tract abnormalities is limited, and to date, there have been no investigations examining NSS and longitudinal white matter development during the prodrome. Mapping the correlates of NSS in ultrahigh-risk (UHR) youth offers potential for highlighting a viable biomarker as well as for advancing understanding of pathogenic processes during the adolescent risk period. METHODS A total of 68 (33 UHR and 35 healthy control) adolescents were assessed with an NSS inventory, structured interviews, and diffusion tensor imaging. Fractional anisotropy (FA) of theoretically relevant cerebellar-thalamic tracts was calculated (left/right superior cerebellar peduncles [SCPs]). Twelve months later, a subset of 30 (15 UHR and 15 control) participants returned for follow-up diffusion tension imaging/clinical assessments. RESULTS UHR youth exhibited elevated NSS across domains. While there were no group differences in the integrity of the SCPs at baseline, controls showed a normative increase while the UHR group showed a decrease in FA over 12 months. NSS predicted a longitudinal decrease in cerebellar-thalamic FA and elevations in negative but not positive symptoms 12 months later. DISCUSSION Findings of abnormal white matter development provide direct empirical evidence to support prominent neurodevelopmental theories. The predictive relationships between NSS and longitudinal cerebellar-thalamic tract integrity and negative symptom course provide insight into the role of cognitive dysmetria in the high-risk period and inform on a unique biomarker tied to core features underlying psychosis.
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Affiliation(s)
- Vijay A. Mittal
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO;,Center for Neuroscience, University of Colorado Boulder, Boulder, CO;,*To whom correspondence should be addressed; Department of Psychology and Neuroscience, University of Colorado at Boulder, 345 UCB, Boulder, CO 80309-0345, US; tel: 310-923-2822, fax: 303-492-4616, e-mail:
| | - Derek J. Dean
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO;,Center for Neuroscience, University of Colorado Boulder, Boulder, CO
| | - Jessica A. Bernard
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO
| | - Joseph M. Orr
- Institute for Cognitive Science, University of Colorado Boulder, Boulder, CO
| | - Andrea Pelletier-Baldelli
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO;,Center for Neuroscience, University of Colorado Boulder, Boulder, CO
| | - Emily E. Carol
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO
| | - Tina Gupta
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO
| | - Jessica Turner
- Department of Psychology, Georgia State University, Atlanta, GA
| | - Daniel R. Leopold
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO;,Center for Neuroscience, University of Colorado Boulder, Boulder, CO
| | - Briana L. Robustelli
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO
| | - Zachary B. Millman
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO
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Carol EE, Mittal VA. Self-reported cannabis use is inconsistent with the results from drug-screening in youth at ultra high-risk for psychosis in Colorado. Schizophr Res 2014; 157:317-8. [PMID: 24924407 PMCID: PMC4134470 DOI: 10.1016/j.schres.2014.05.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 05/19/2014] [Accepted: 05/22/2014] [Indexed: 11/17/2022]
Affiliation(s)
- Emily E Carol
- University of Colorado Boulder, Department of Psychology and Neuroscience, United States; University of Colorado Boulder, Center for Neuroscience, United States.
| | - Vijay A Mittal
- University of Colorado Boulder, Department of Psychology and Neuroscience, United States; University of Colorado Boulder, Center for Neuroscience, United States
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17
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Hooker CI, Carol EE, Eisenstein T, Yin H, Lincoln SH, Tully LM, Dodell-Feder D, Nahum M, Keshavan MS, Seidman LJ. A pilot study of cognitive training in clinical high risk for psychosis: initial evidence of cognitive benefit. Schizophr Res 2014; 157:314-6. [PMID: 24954429 PMCID: PMC4384393 DOI: 10.1016/j.schres.2014.05.034] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 05/20/2014] [Accepted: 05/23/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Christine I. Hooker
- Harvard University, Department of Psychology, 33 Kirkland St., Cambridge MA 02138,Corresponding author: Christine I. Hooker, Ph.D. Harvard University, Department of Psychology, 1020 William James Hall,.33 Kirkland St., Cambridge MA 02138, , Phone: 510-289-1102
| | - Emily E. Carol
- Harvard University, Department of Psychology, 33 Kirkland St., Cambridge MA 02138
| | - T.J. Eisenstein
- Harvard University, Department of Psychology, 33 Kirkland St., Cambridge MA 02138
| | - Hong Yin
- Harvard University, Department of Psychology, 33 Kirkland St., Cambridge MA 02138
| | - Sarah Hope Lincoln
- Harvard University, Department of Psychology, 33 Kirkland St., Cambridge MA 02138
| | - Laura M. Tully
- Harvard University, Department of Psychology, 33 Kirkland St., Cambridge MA 02138
| | - David Dodell-Feder
- Harvard University, Department of Psychology, 33 Kirkland St., Cambridge MA 02138
| | - Mor Nahum
- Department of Optometry, 487 Minor Hall, University of California, Berkeley, CA 94720
| | - Matcheri S. Keshavan
- Beth Israel Deaconess Medical Center, Public Psychiatry Division at the Massachusetts Mental Health Center, 75 Fenwood Rd., Boston MA 02115,Harvard Medical School, Department of Psychiatry, Boston MA 02115
| | - Larry J. Seidman
- Beth Israel Deaconess Medical Center, Public Psychiatry Division at the Massachusetts Mental Health Center, 75 Fenwood Rd., Boston MA 02115,Harvard Medical School, Department of Psychiatry, Boston MA 02115
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Dean DJ, Bernard JA, Orr JM, Pelletier-Baldelli A, Gupta T, Carol EE, Mittal VA. Cerebellar Morphology and Procedural Learning Impairment in Neuroleptic-Naive Youth at Ultrahigh Risk of Psychosis. Clin Psychol Sci 2013; 2:152-164. [PMID: 25419496 DOI: 10.1177/2167702613500039] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Despite evidence suggesting a role for cerebellar abnormalities in the pathogenesis of psychosis, the structure has yet to receive attention in individuals at ultrahigh risk for psychosis (UHR). Accumulating research has suggested that the cerebellum helps modulate cognition and movement, domains in which UHR individuals show impairment; understanding putative markers of risk, such as structural abnormalities and behavioral correlates, is essential. In this study, participants underwent a high-resolution structural brain scan and participated in a pursuit rotor experiment. Cerebellar regions associated with movement (anterior cerebellum) and cognition (crus I) were subsequently analyzed. UHR participants showed impaired performance on the pursuit rotor task, learned at a slower rate, and showed smaller cerebellar volumes compared with control participants. Left crus I volume was significantly associated with poor rate of learning. The present results suggest that cerebellar abnormalities and their behavioral correlates (poor learning and motor control) precede the onset of psychosis.
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Affiliation(s)
- Derek J Dean
- Department of Psychology and Neuroscience, University of Colorado Boulder ; Center for Neuroscience, University of Colorado Boulder
| | | | - Joseph M Orr
- Department of Psychology and Neuroscience, University of Colorado Boulder ; Institute for Cognitive Science, University of Colorado Boulder
| | - Andrea Pelletier-Baldelli
- Department of Psychology and Neuroscience, University of Colorado Boulder ; Center for Neuroscience, University of Colorado Boulder
| | - Tina Gupta
- Department of Psychology and Neuroscience, University of Colorado Boulder
| | - Emily E Carol
- Department of Psychology and Neuroscience, University of Colorado Boulder
| | - Vijay A Mittal
- Department of Psychology and Neuroscience, University of Colorado Boulder ; Center for Neuroscience, University of Colorado Boulder
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