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Cowan HR, Williams TF, Mittal VA, Addington J, Bearden CE, Cadenhead KS, Cannon TD, Cornblatt BA, Keshevan M, Perkins DO, Mathalon DH, Stone W, Woods SW, Walker EF. The Complex Latent Structure of Attenuated Psychotic Symptoms: Hierarchical and Bifactor Models of SIPS Symptoms Replicated in Two Large Samples at Clinical High Risk for Psychosis. Schizophr Bull 2024:sbae042. [PMID: 38728417 DOI: 10.1093/schbul/sbae042] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
BACKGROUND AND HYPOTHESIS The Structured Interview for Psychosis-Risk Syndromes (SIPS) and other assessments of psychosis risk define clinical high risk for psychosis (CHR) by the presence of attenuated psychotic symptoms. Despite extensive research on attenuated psychotic symptoms, substantial questions remain about their internal psychometric structure and relationships to comorbid non-psychotic symptoms. STUDY DESIGN Hierarchical and bifactor models were developed for the SIPS in a large CHR sample (NAPLS-3, N = 787) and confirmed through preregistered replication in an independent sample (NAPLS-2, N = 1043). Criterion validity was tested through relationships with CHR status, comorbid symptoms/diagnoses, functional impairment, demographics, neurocognition, and conversion to psychotic disorders. STUDY RESULTS Most variance in SIPS items (75%-77%) was attributable to a general factor. Hierarchical and bifactor models included a general factor and five specific/lower-order factors (positive symptoms, eccentricity, avolition, lack of emotion, and deteriorated thought process). CHR participants were elevated on the general factor and the positive symptoms factor. The general factor was associated with depressive symptoms; functional impairment; and mood, anxiety, and schizotypal personality diagnoses. The general factor was the best predictor of psychotic disorders (d ≥ 0.50). Positive symptoms and eccentricity had specific effects on conversion outcomes. The deteriorated thought process was least meaningful/replicable. CONCLUSIONS Attenuated psychotic symptoms, measured by the SIPS, have a complex hierarchical structure with a strong general factor. The general factor relates to internalizing symptoms and functional impairment, emphasizing the roles of general psychopathological distress/impairment in psychosis risk. Shared symptom variance complicates the interpretation of raw symptom scores. Broad transdiagnostic assessment is warranted to model psychosis risk accurately.
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Affiliation(s)
- Henry R Cowan
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA
- Department of Psychology, Michigan State University, East Lansing, MI, USA
| | - Trevor F Williams
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - Vijay A Mittal
- Department of Psychology, Northwestern University, Evanston, IL, USA
- Departments of Psychiatry and Medical Social Sciences, Northwestern University, Evanston, IL, USA
| | - Jean Addington
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Carrie E Bearden
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
| | - Kristin S Cadenhead
- Department of Psychiatry, University of California San Diego, San Diego, USA
| | - Tyrone D Cannon
- Department of Psychology, Yale University, New Haven, CT, USA
- Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Barbara A Cornblatt
- Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, NY, USA
| | - Matcheri Keshevan
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts General Hospital, Boston, MA, USA
| | - Diana O Perkins
- Department of Psychiatry, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | - Daniel H Mathalon
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA
| | - William Stone
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts General Hospital, Boston, MA, USA
| | - Scott W Woods
- Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Elaine F Walker
- Department of Psychology, Emory University, Atlanta, GA, USA
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Cowan HR, Mittal VA, Addington J, Bearden CE, Cadenhead KS, Cornblatt BA, Keshavan M, Mathalon DH, Perkins DO, Stone W, Tsuang MT, Woods SW, Cannon TD, Walker EF. Longitudinal Trajectories of Premorbid Social and Academic Adjustment in Youth at Clinical High Risk for Psychosis: Implications for Conversion. Schizophr Bull 2024:sbae050. [PMID: 38706103 DOI: 10.1093/schbul/sbae050] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
BACKGROUND AND HYPOTHESIS Social and academic adjustment deteriorate in the years preceding a psychotic disorder diagnosis. Analyses of premorbid adjustment have recently been extended into the clinical high risk for psychosis (CHR) syndrome to identify risk factors and developmental pathways toward psychotic disorders. Work so far has been at the between-person level, which has constrained analyses of premorbid adjustment, clinical covariates, and conversion to psychosis. STUDY DESIGN Growth-curve models examined longitudinal trajectories in retrospective reports of premorbid social and academic adjustment from youth at CHR (n = 498). Interaction models tested whether known covariates of premorbid adjustment problems (attenuated negative symptoms, cognition, and childhood trauma) were associated with different premorbid adjustment trajectories in converters vs non-converters (ie, participants who did/did not develop psychotic disorders within 2-year follow-up). STUDY RESULTS Converters reported poorer social adjustment throughout the premorbid period. Converters who developed psychosis with an affective component reported poorer academic adjustment throughout the premorbid period than those who developed non-affective psychosis. Tentatively, baseline attenuated negative symptoms may have been associated with worsening social adjustment in the premorbid period for non-converters only. Childhood trauma impact was associated with fewer academic functioning problems among converters. Cognition effects did not differ based on conversion status. CONCLUSIONS Premorbid social function is an important factor in risk for conversion to psychosis. Negative symptoms and childhood trauma had different relationships to premorbid functioning in converters vs non-converters. Mechanisms linking symptoms and trauma to functional impairment may be different in converters vs non-converters, suggesting possible new avenues for risk assessment.
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Affiliation(s)
- Henry R Cowan
- Psychiatry, The Ohio State University, Columbus, OH, USA
- Psychology, Michigan State University, East Lansing, MI, USA
| | - Vijay A Mittal
- Psychology, Psychiatry, Medical Social Sciences, Northwestern University, Evanston, IL, USA
| | | | - Carrie E Bearden
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, USA
- Psychology, University of California Los Angeles, Los Angeles, CA, USA
| | | | | | - Matcheri Keshavan
- Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts General Hospital, Boston, MA, USA
| | - Daniel H Mathalon
- Psychiatry, University of California San Francisco, San Francisco, CA, USA
- San Francisco VA Medical Center, San Francisco, CA, USA
| | - Diana O Perkins
- Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - William Stone
- Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts General Hospital, Boston, MA, USA
| | - Ming T Tsuang
- Psychiatry, University of California San Diego, San Diego, CA, USA
| | | | - Tyrone D Cannon
- Psychiatry, Yale University, New Haven, CT, USA
- Psychology, Yale University, New Haven, CT, USA
| | - Elaine F Walker
- Psychology and Psychiatry, Emory University, Atlanta, GA, USA
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Hamilton SA, Wastler HM, Moe AM, Cowan HR, Lundin NB, Guirgis HH, Parris CJ, Stearns WH, Manges ME, Holmes AC, Blouin AM, Breitborde NJK. Symptomatic and Functional Outcomes Among Individuals at High Risk for Psychosis Participating in Step-Based Care. Psychiatr Serv 2024; 75:496-499. [PMID: 38088038 DOI: 10.1176/appi.ps.20230188] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Validated, multicomponent treatments designed to address symptoms and functioning of individuals at clinical high risk for psychosis are currently lacking. The authors report findings of a study with such individuals participating in step-based care-a program designed to provide low-intensity, non-psychosis-specific interventions and advancement to higher-intensity, psychosis-specific interventions only if an individual is not meeting criteria for a clinical response. Among individuals with symptomatic or functional concerns at enrollment, 67% met criteria for a symptomatic response (median time to response=11.1 weeks), and 64% met criteria for a functional response (median time to response=8.9 weeks).
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Affiliation(s)
- Sarah A Hamilton
- Department of Psychiatry and Behavioral Health (all authors) and Department of Psychology (Moe, Breitborde), Ohio State University, Columbus
| | - Heather M Wastler
- Department of Psychiatry and Behavioral Health (all authors) and Department of Psychology (Moe, Breitborde), Ohio State University, Columbus
| | - Aubrey M Moe
- Department of Psychiatry and Behavioral Health (all authors) and Department of Psychology (Moe, Breitborde), Ohio State University, Columbus
| | - Henry R Cowan
- Department of Psychiatry and Behavioral Health (all authors) and Department of Psychology (Moe, Breitborde), Ohio State University, Columbus
| | - Nancy B Lundin
- Department of Psychiatry and Behavioral Health (all authors) and Department of Psychology (Moe, Breitborde), Ohio State University, Columbus
| | - Hossam H Guirgis
- Department of Psychiatry and Behavioral Health (all authors) and Department of Psychology (Moe, Breitborde), Ohio State University, Columbus
| | - Craig J Parris
- Department of Psychiatry and Behavioral Health (all authors) and Department of Psychology (Moe, Breitborde), Ohio State University, Columbus
| | - Walter H Stearns
- Department of Psychiatry and Behavioral Health (all authors) and Department of Psychology (Moe, Breitborde), Ohio State University, Columbus
| | - Margaret E Manges
- Department of Psychiatry and Behavioral Health (all authors) and Department of Psychology (Moe, Breitborde), Ohio State University, Columbus
| | - Anne C Holmes
- Department of Psychiatry and Behavioral Health (all authors) and Department of Psychology (Moe, Breitborde), Ohio State University, Columbus
| | - Alexandra M Blouin
- Department of Psychiatry and Behavioral Health (all authors) and Department of Psychology (Moe, Breitborde), Ohio State University, Columbus
| | - Nicholas J K Breitborde
- Department of Psychiatry and Behavioral Health (all authors) and Department of Psychology (Moe, Breitborde), Ohio State University, Columbus
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Williams TF, Williams AL, Cowan HR, Walker EF, Cannon TD, Bearden CE, Keshavan M, Cornblatt BA, Addington J, Woods SW, Perkins DO, Mathalon DH, Cadenhead KS, Stone WS, Mittal VA. The hierarchical taxonomy of psychopathology in clinical high risk for psychosis: Validation and extension. J Psychopathol Clin Sci 2024; 133:235-244. [PMID: 38546628 DOI: 10.1037/abn0000893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
The Hierarchical Taxonomy of Psychopathology (HiTOP) consortium's transdiagnostic dimensional model of psychopathology has considerable support; however, this model has been underresearched in individuals at clinical high risk for psychosis (CHR-P), a population that may advance the model. CHR-P individuals not only have attenuated psychotic symptoms that vary in severity, but also have many comorbid diagnoses and varied clinical outcomes, including disorders with uncertain relations to HiTOP (e.g., obsessive-compulsive disorder). The present study used self-report and interview data from North American Prodrome Longitudinal Study-3 (710 CHR, 96 controls) to replicate the HiTOP model and test specific hypotheses regarding disorders with uncertain relations to its dimensions. Additionally, the present study examined the HiTOP model in relation to childhood trauma, declines in social functioning, and development of full psychosis. Confirmatory factor analysis indicated that the HiTOP model's fit was nearly adequate (e.g., comparative fit index = .89), though several theory-relevant modifications were indicated. Additionally, specific tests were conducted to gain a more fine-grained perspective on how disorders with less clear prior evidence were related to the HiTOP model. Notable findings from these analyses include bipolar spectrum disorders relating to the psychosis super spectrum (i.e., .39 loading), and obsessive-compulsive disorder showing a complex pattern of loadings (e.g., internalizing and psychosis). The final model parsimoniously accounted for childhood trauma (e.g., super spectra rs = .22-.32), associations with current functioning, and predicted future conversion to a psychotic disorder (e.g., super spectra R² = .13). Overall, these results inform the HiTOP model and suggest its promise for CHR-P research. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
| | | | | | | | | | - Carrie E Bearden
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles
| | - Matcheri Keshavan
- Department of Psychiatry, Harvard Medical School, Beth Israel Deaconess Medical Center
| | | | - Jean Addington
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary
| | | | - Diana O Perkins
- Department of Psychiatry, University of North Carolina, Chapel Hill
| | | | | | - William S Stone
- Department of Psychiatry, Harvard Medical School, Beth Israel Deaconess Medical Center
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Lundin NB, Blouin AM, Cowan HR, Moe AM, Wastler HM, Breitborde NJK. Identification of Psychosis Risk and Diagnosis of First-Episode Psychosis: Advice for Clinicians. Psychol Res Behav Manag 2024; 17:1365-1383. [PMID: 38529082 PMCID: PMC10962362 DOI: 10.2147/prbm.s423865] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 03/07/2024] [Indexed: 03/27/2024] Open
Abstract
Early detection of psychotic-spectrum disorders among adolescents and young adults is crucial, as the initial years after psychotic symptom onset encompass a critical period in which psychosocial and pharmacological interventions are most effective. Moreover, clinicians and researchers in recent decades have thoroughly characterized psychosis-risk syndromes, in which youth are experiencing early warning signs indicative of heightened risk for developing a psychotic disorder. These insights have created opportunities for intervention even earlier in the illness course, ideally culminating in the prevention or mitigation of psychosis onset. However, identification and diagnosis of early signs of psychosis can be complex, as clinical presentations are heterogeneous, and psychotic symptoms exist on a continuum. When a young person presents to a clinic, it may be unclear whether they are experiencing common, mild psychotic-like symptoms, early warning signs of psychosis, overt psychotic symptoms, or symptoms better accounted for by a non-psychotic disorder. Therefore, the purpose of this review is to provide a framework for clinicians, including those who treat non-psychotic disorders and those in primary care settings, for guiding identification and diagnosis of early psychosis within the presenting clinic or via referral to a specialty clinic. We first provide descriptions and examples of first-episode psychosis (FEP) and psychosis-risk syndromes, as well as assessment tools used to diagnose these conditions. Next, we provide guidance as to the differential diagnosis of conditions which have phenotypic overlap with psychotic disorders, while considering the possibility of co-occurring symptoms in which case transdiagnostic treatments are encouraged. Finally, we conclude with an overview of early detection screening and outreach campaigns, which should be further optimized to reduce the duration of untreated psychosis among youth.
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Affiliation(s)
- Nancy B Lundin
- Early Psychosis Intervention Center, Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA
| | - Alexandra M Blouin
- Early Psychosis Intervention Center, Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA
| | - Henry R Cowan
- Early Psychosis Intervention Center, Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA
- Department of Psychology, Michigan State University, East Lansing, MI, USA
| | - Aubrey M Moe
- Early Psychosis Intervention Center, Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA
- Department of Psychology, The Ohio State University, Columbus, OH, USA
| | - Heather M Wastler
- Early Psychosis Intervention Center, Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA
| | - Nicholas J K Breitborde
- Early Psychosis Intervention Center, Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA
- Department of Psychology, The Ohio State University, Columbus, OH, USA
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Cowan HR, Williams TF, Schiffman J, Ellman LM, Mittal VA. Mapping Psychosis Risk States onto the Hierarchical Taxonomy of Psychopathology Using Hierarchical Symptom Dimensions. Clin Psychol Sci 2024; 12:3-21. [PMID: 38572185 PMCID: PMC10989734 DOI: 10.1177/21677026221146178] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
Clinical high risk for psychosis (CHR) is a transdiagnostic risk state. However, it is unclear how risk states such as CHR fit within broad transdiagnostic models such as the Hierarchical Taxonomy of Psychopathology (HiTOP). In this study, a hierarchical dimensional symptom structure was defined by unfolding factor analysis of self-report data from 3,460 young adults (mage=20.3). A subsample (n=436) completed clinical interviews, 85 of whom met CHR criteria. Regression models examined relationships between symptom dimensions, CHR status, and clinician-rated symptoms. CHR status was best explained by a reality distortion dimension, with contributions from internalizing dimensions. Positive and negative attenuated psychotic symptoms were best explained by multiple psychotic and nonpsychotic symptom dimensions including reality distortion, distress, fear, detachment, and mania. Attenuated psychotic symptoms are a complex presenting problem warranting comprehensive assessment. HiTOP can provide both diagnostic precision and broad transdiagnostic coverage, making it a valuable resource for use with at-risk individuals.
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Affiliation(s)
- Henry R. Cowan
- Psychology, Northwestern University, Evanston, IL
- Psychiatry, The Ohio State University, Columbus, OH
| | | | | | - Lauren M. Ellman
- Psychology and Neuroscience, Temple University, Philadelphia, PA
| | - Vijay A. Mittal
- Psychology, Northwestern University, Evanston, IL
- Psychiatry and Institute for Policy Research, Northwestern University, Evanston, IL
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Wastler HM, Cowan HR, Hamilton SA, Lundin NB, Manges M, Moe AM, Breitborde NJK. Within-Person Relationship between Attenuated Positive Symptoms and Suicidal Ideation among Individuals at Clinical High Risk for Psychosis. Arch Suicide Res 2023:1-14. [PMID: 37840314 DOI: 10.1080/13811118.2023.2269209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
Individuals at clinical high-risk for psychosis (CHR-P) are at increased risk for suicide. However, the relationship between attenuated positive symptoms and suicidal ideation are not well understood, particularly as they interact over time. The current study addressed this gap in the literature. We hypothesized that greater attenuated symptoms would be concurrently and prospectively associated with suicidal ideation. Further, we hypothesized that suspiciousness and perceptual abnormalities would have the strongest relationship with suicidal ideation. Within-person variation in symptoms and suicidal ideation were examined across 24 treatment sessions for individuals at CHR-P. Attenuated positive symptoms (unusual thought content, suspiciousness, grandiose ideas, perceptual abnormalities, and disorganized communication) and suicidal ideation were assessed at each session. Logistic mixed effect models examined concurrent and time-lagged relationships between symptoms and suicidal ideation among 36 individuals at CHR-P. Results indicated that suicidal ideation was more likely during weeks when participants reported more severe total attenuated positive symptoms. Further, suspiciousness was uniquely associated with suicidal ideation, both concurrently and at the following session. Post hoc models examined the reverse direction of this relationship, demonstrating that suicidal ideation also prospectively predicted suspiciousness at the following session. These results suggest that within-person attenuated symptoms, particularly suspiciousness, are associated with suicidal ideation among individuals at CHR-P. However, the bidirectional relationship between suspiciousness and suicidal ideation raises questions about causal nature of this relationship. Further research is needed to examine the dynamic interplay of suspiciousness and suicidal ideation.
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Cowan HR, McAdams DP, Ouellet L, Jones CM, Mittal VA. Self-concept and Narrative Identity in Youth at Clinical High Risk for Psychosis. Schizophr Bull 2023:sbad142. [PMID: 37816626 DOI: 10.1093/schbul/sbad142] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/12/2023]
Abstract
BACKGROUND AND HYPOTHESIS Disturbances of the narrative self and personal identity accompany the onset of psychotic disorders in late adolescence and early adulthood (a formative developmental stage for self-concept and personal narratives). However, these issues have primarily been studied retrospectively after illness onset, limiting any inferences about their developmental course. STUDY DESIGN Youth at clinical high risk for psychosis (CHR) (n = 49) and matched healthy comparison youth (n = 52) completed a life story interview (including self-defining memory, turning point, life challenge, and psychotic-like experience) and questionnaires assessing self-esteem, self-beliefs, self-concept clarity, and ruminative/reflective self-focus. Trained raters coded interviews for narrative identity themes of emotional tone, agency, temporal coherence, context coherence, self-event connections, and meaning-making (intraclass correlations >0.75). Statistical analyses tested group differences and relationships between self-concept, narrative identity, symptoms, and functioning. STUDY RESULTS CHR participants reported more negative self-esteem and self-beliefs, poorer self-concept clarity, and more ruminative self-focus, all of which related to negative symptoms. CHR participants narrated their life stories with themes of negative emotion and passivity (ie, lack of personal agency), which related to positive and negative symptoms. Reflective self-focus and autobiographical reasoning were unaffected and correlated. Autobiographical reasoning was uniquely associated with preserved role functioning. CONCLUSIONS This group of youth at CHR exhibited some, but not all, changes to self-concept and narrative identity seen in psychotic disorders. A core theme of negativity, uncertainty, and passivity ran through their semantic and narrative self-representations. Preserved self-reflection and autobiographical reasoning suggest sources of resilience and potential footholds for cognitive-behavioral and metacognitive interventions.
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Affiliation(s)
- Henry R Cowan
- Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA
| | - Dan P McAdams
- Psychology, Northwestern University, Evanston, IL, USA
| | - Leah Ouellet
- Human Development and Social Policy, Northwestern University, Evanston, IL, USA
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Wastler HM, Cowan HR, Hamilton SA, Lundin NB, Manges M, Moe AM, Breitborde NJK. Variability in suicidal ideation during treatment for individuals at clinical high risk for psychosis: The importance of repeated assessment. Early Interv Psychiatry 2023; 17:1038-1041. [PMID: 37021533 DOI: 10.1111/eip.13413] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 02/01/2023] [Accepted: 03/28/2023] [Indexed: 04/07/2023]
Abstract
AIM Suicide risk is elevated among individuals at clinical high risk for psychosis (CHR-P). The current study examined variability in suicidal ideation during treatment for individuals at CHR-P. METHODS A retrospective chart review was used to examine the course of suicidal ideation during 16 sessions of individual psychotherapy for 25 individuals at CHR-P. RESULTS Suicidal ideation was reported by 24% of participants at session 1 and 16% at session 16, with minimal within-subject change in the presence of suicidal ideation across the two time points. However, a more fine-grained investigation at each session indicated that 60% of individuals at CHR-P experienced suicidal ideation at least once during treatment. Additionally, there was great variability in suicidal ideation both within and between participants over the course of the 16 sessions. CONCLUSIONS These findings highlight the importance of repeated assessment when examining suicidal ideation as a treatment outcome for individuals at CHR-P.
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Affiliation(s)
- Heather M Wastler
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, Ohio, USA
| | - Henry R Cowan
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, Ohio, USA
| | - Sarah A Hamilton
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, Ohio, USA
| | - Nancy B Lundin
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, Ohio, USA
| | - Margaret Manges
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, Ohio, USA
| | - Aubrey M Moe
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, Ohio, USA
- Department of Psychology, The Ohio State University, Columbus, Ohio, USA
| | - Nicholas J K Breitborde
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, Ohio, USA
- Department of Psychology, The Ohio State University, Columbus, Ohio, USA
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Lundin NB, Cowan HR, Singh DK, Moe AM. Lower cohesion and altered first-person pronoun usage in the spoken life narratives of individuals with schizophrenia. Schizophr Res 2023; 259:140-149. [PMID: 37127466 PMCID: PMC10524354 DOI: 10.1016/j.schres.2023.04.001] [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: 11/15/2022] [Revised: 03/17/2023] [Accepted: 04/05/2023] [Indexed: 05/03/2023]
Abstract
Usage of computational tools to quantify language disturbances among individuals with psychosis is increasing, improving measurement efficiency and access to fine-grained constructs. However, few studies apply automated linguistic analysis to life narratives in this population. Such research could facilitate the measurement of psychosis-relevant constructs such as sense of agency, capacity to organize one's personal history, narrative richness, and perceptions of the roles that others play in one's life. Furthermore, research is needed to understand how narrative linguistic features relate to cognitive and social functioning. In the present study, individuals with schizophrenia (n = 32) and individuals without a psychotic disorder (n = 15) produced personal life narratives within the Indiana Psychiatric Illness Interview. Narratives were analyzed using the Coh-Metrix computational tool. Linguistic variables analyzed were indices of connections within causal and goal-driven speech (deep cohesion), unique word usage (lexical diversity), and pronoun usage. Individuals with schizophrenia compared to control participants produced narratives that were lower in deep cohesion, contained more first-person singular pronouns, and contained fewer first-person plural pronouns. Narratives did not significantly differ between groups in lexical diversity, third-person pronoun usage, or total word count. Cognitive-linguistic relationships emerged in the full sample, including significant correlations between greater working memory capacity and greater deep cohesion and lexical diversity. In the schizophrenia group, social problem-solving abilities did not correlate with linguistic variables but were associated with cognition. Findings highlight the relevance of psychotherapies which aim to promote recovery among individuals with psychosis through the construction of coherent life narratives and increasing agency and social connectedness.
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Affiliation(s)
- Nancy B Lundin
- Department of Psychiatry and Behavioral Health, The Ohio State University, 1670 Upham Drive, Suite 460, Columbus, OH 43210, USA.
| | - Henry R Cowan
- Department of Psychiatry and Behavioral Health, The Ohio State University, 1670 Upham Drive, Suite 460, Columbus, OH 43210, USA.
| | - Divnoor K Singh
- Department of Neuroscience, The Ohio State University, 1585 Neil Avenue, Columbus, OH 43210, USA.
| | - Aubrey M Moe
- Department of Psychiatry and Behavioral Health, The Ohio State University, 1670 Upham Drive, Suite 460, Columbus, OH 43210, USA; Department of Psychology, The Ohio State University, 1835 Neil Avenue, Columbus, OH 43210, USA.
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Cowan HR, Lundin NB, Moe AM, Breitborde NJK. Discrepancies between self and caregiver perceptions of agency in first-episode psychosis. J Psychiatr Res 2023; 162:220-227. [PMID: 37201222 DOI: 10.1016/j.jpsychires.2023.05.035] [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] [Received: 03/17/2023] [Revised: 05/01/2023] [Accepted: 05/03/2023] [Indexed: 05/20/2023]
Abstract
Personal agency-a key element of recovery from psychotic disorders-is formed and maintained in large part through interactions with others. Interactions with caregivers are particularly important in first-episode psychosis (FEP), as these interactions form the foundations for lifelong caregiving relationships. The present study examined shared understandings of agency (operationalized as efficacy to manage symptoms and social behaviors) within families affected by FEP. Individuals with FEP (n = 46) completed the Self-Efficacy Scale for Schizophrenia (SESS) and measures of symptom severity, social functioning, social quality of life, stigma, and discrimination. Caregivers (n = 42) completed a caregiver version of the SESS assessing perceptions of their affected relative's self-efficacy. Self-rated efficacy was higher than caregiver-rated efficacy in all domains (positive symptoms, negative symptoms, and social behavior). Self- and caregiver-rated efficacy correlated only in the social behavior domain. Self-rated efficacy was most associated with lower depression and stigmatization, whereas caregiver-rated efficacy was most associated with better social functioning. Psychotic symptoms did not relate to self- or caregiver-rated efficacy. Individuals with FEP and caregivers have discrepant perceptions of personal agency, perhaps because they base perceptions of agency on different sources of information. These findings highlight specific targets for psychoeducation, social skills training, and assertiveness training to develop shared understandings of agency and facilitate functional recovery.
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Affiliation(s)
- Henry R Cowan
- Psychiatry and Behavioral Health, The Ohio State University, USA.
| | - Nancy B Lundin
- Psychiatry and Behavioral Health, The Ohio State University, USA
| | - Aubrey M Moe
- Psychiatry and Behavioral Health, The Ohio State University, USA; Psychology, The Ohio State University, USA
| | - Nicholas J K Breitborde
- Psychiatry and Behavioral Health, The Ohio State University, USA; Psychology, The Ohio State University, USA
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12
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Turner AF, Couch NG, Cowan HR, Otto-Meyer R, Murthy P, Logan RL, Rogers LO, McAdams DP. The Good and the Bad in Black and White: Stories of Life’s High and Low Points Told by Black and White Midlife Adults in America. Journal of Research in Personality 2022. [DOI: 10.1016/j.jrp.2022.104298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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13
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Patton HN, Cowan HR, Mittal VA. Changes in core beliefs over time predict symptoms and functioning in clinical high risk for psychosis. Early Interv Psychiatry 2022; 16:311-315. [PMID: 33938147 DOI: 10.1111/eip.13156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Received: 11/13/2020] [Revised: 03/23/2021] [Indexed: 11/30/2022]
Abstract
AIM The current study examined whether changes in core beliefs over time predict positive symptoms, negative symptoms, social functioning, and role functioning within individuals at clinical high risk for psychosis (CHR). METHODS CHR participants (N = 73) completed the Brief Core Schemas Scale (BCSS) at baseline, with a subset of participants (n = 54) completing study procedures at a 12-month follow-up. Attenuated psychotic symptoms, social, and role functioning were assessed at both timepoints. RESULTS Hierarchical regression analyses showed that changes in self-beliefs between baseline and follow-up predicted worsening social and role functioning at 12-month follow-up, with trends suggesting they also predicted negative and positive symptoms at 12-month follow-up. The independent effect of an increase in negative self-beliefs marginally or significantly predicted all outcomes of interest. CONCLUSIONS The current study shows incremental validity of self-beliefs from a novel perspective. It suggests that worsening self-beliefs have a clinically meaningful impact within CHR populations.
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Affiliation(s)
| | - Henry R Cowan
- Psychology, Northwestern University, Evanston, Illinois, USA
| | - Vijay A Mittal
- Psychology, Psychiatry, Medical Social Sciences, Northwestern University, Evanston, Illinois, USA
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14
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Affiliation(s)
- Kasia Hitczenko
- Department of Linguistics, Northwestern University, Evanston, IL, USA,To whom correspondence should be addressed; Department of Linguistics, Northwestern University, 2016 Sheridan Road, Evanston, IL 60208, USA; tel: 847-491-5831, fax: 847-491-3770, e-mail:
| | - Henry R Cowan
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - Matthew Goldrick
- Department of Linguistics, Northwestern University, Evanston, IL, USA,Department of Psychology, Northwestern University, Evanston, IL, USA,Institute for Innovations in Developmental Sciences, Northwestern University, Evanston/Chicago, IL, USA
| | - Vijay A Mittal
- Department of Psychology, Northwestern University, Evanston, IL, USA,Institute for Innovations in Developmental Sciences, Northwestern University, Evanston/Chicago, IL, USA,Department of Psychiatry, Northwestern University, Chicago, IL, USA,Institute for Policy Research, Northwestern University, Evanston, IL, USA,Medical Social Sciences, Northwestern University, Chicago, IL, USA
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15
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Gupta T, Strauss GP, Cowan HR, Pelletier-Baldelli A, Ellman LM, Schiffman J, Mittal VA. Secondary Sources of Negative Symptoms in Those Meeting Criteria for a Clinical High-Risk Syndrome. Biol Psychiatry Glob Open Sci 2021; 1:210-218. [PMID: 35415704 PMCID: PMC8996819 DOI: 10.1016/j.bpsgos.2021.05.008] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 04/30/2021] [Accepted: 05/18/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Negative symptoms are diagnostic characteristics of schizophrenia. They can result from primary (i.e., idiopathic) or secondary (i.e., due to other factors such as depression, anxiety, psychosis, disorganization, medication effects) features of the illness. Although secondary sources of negative symptoms are prevalent among individuals meeting criteria for clinical high-risk syndromes that are due to high rates of comorbidity, the extent to which secondary sources account for variance in negative symptom domains is unknown. Addressing this gap is an important step in informing vulnerability models and treatments for negative symptoms. This study aimed to investigate secondary sources of negative symptoms in those meeting criteria for a clinical high-risk syndrome (N = 192). METHODS Simultaneous regression and hierarchical partitioning methods were used to determine the proportion of variance explained by selective serotonin reuptake inhibitor use, anxiety, depression, unusual thought content, and disorganized communication in predicting severity of five negative symptom domains (avolition, anhedonia, asociality, blunted affect, and alogia). RESULTS Findings revealed that depression explained the largest proportion of variance in avolition, asociality, and anhedonia. Anxiety was the most predictive of blunted affect, and selective serotonin reuptake inhibitor use explained the most variance in alogia. Analyses within male and female samples revealed that in males, depression explained a large proportion of variance in several negative symptom domains, while in females, selective serotonin reuptake inhibitor use explained variance in alogia. CONCLUSIONS Results highlight heterogeneity in variance explained by secondary sources of negative symptoms. These findings guide treatment development for secondary sources of negative symptoms. Furthermore, results inform etiologic models of psychosis and negative symptom conceptualizations.
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Affiliation(s)
- Tina Gupta
- Department of Psychology, Northwestern University, Evanston, Illinois
| | | | - Henry R. Cowan
- Department of Psychology, Northwestern University, Evanston, Illinois
| | | | - Lauren M. Ellman
- Department of Psychology, Temple University, Philadelphia, Pennsylvania
| | - Jason Schiffman
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, Maryland
- Department of Psychological Science, University of California, Irvine, Irvine, California
| | - Vijay A. Mittal
- Department of Psychology, Northwestern University, Evanston, Illinois
- Department of Psychiatry, Northwestern University, Evanston, Illinois
- Department of Medical Social Science, Northwestern University, Evanston, Illinois
- Institute for Policy Research, Northwestern University, Evanston, Illinois
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16
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Cowan HR, Mittal VA, McAdams DP. Narrative identity in the psychosis spectrum: A systematic review and developmental model. Clin Psychol Rev 2021; 88:102067. [PMID: 34274799 DOI: 10.1016/j.cpr.2021.102067] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 05/31/2021] [Accepted: 07/06/2021] [Indexed: 01/19/2023]
Abstract
Individuals with schizophrenia-spectrum disorders face profound challenges as they attempt to maintain identity through the course of illness. Narrative identity-the study of internalized, evolving life stories-provides a rich theoretical and empirical perspective on these challenges. Based on evidence from a systematic review of narrative identity in the psychosis spectrum (30 studies, combined N = 3859), we argue that the narrative identities of individuals with schizophrenia-spectrum disorders are distinguished by three features: disjointed structure, a focus on suffering, and detached narration. Psychotic disorders typically begin to emerge during adolescence and emerging adulthood, which are formative developmental stages for narrative identity, so it is particularly informative to understand identity disturbances from a developmental perspective. We propose a developmental model in which a focus on suffering emerges in childhood; disjointed structure emerges in middle and late adolescence; and detached narration emerges before or around the time of a first psychotic episode. Further research with imminent risk and early course psychosis populations would be needed to test these predictions. The disrupted life stories of individuals on the psychosis spectrum provide multiple rich avenues for further research to understand narrative self-disturbances.
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Affiliation(s)
| | - Vijay A Mittal
- Psychology, Psychiatry, Medical and Social Sciences, Institute for Policy Research, Northwestern University, United States
| | - Dan P McAdams
- Psychology, School of Education and Social Policy, Northwestern University, United States
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17
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Cowan HR, Mittal VA. Three types of psychotic-like experiences in youth at clinical high risk for psychosis. Eur Arch Psychiatry Clin Neurosci 2021; 271:733-744. [PMID: 32458109 PMCID: PMC7688559 DOI: 10.1007/s00406-020-01143-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 01/28/2020] [Accepted: 05/15/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND A fully dimensional model of psychosis implies that psychotic-like experiences (PLEs) connect the entire psychosis spectrum. Three types of self-reported PLEs-persecutory ideation, bizarre experiences, and perceptual abnormalities-are commonly found in the general population. This study assessed the construct, predictive, and incremental validity of self-reported PLEs in youth at clinical high risk for psychotic disorders (CHR). METHODS Self-report data on PLEs (community assessment of psychic experiences; CAPE) were collected from 105 CHR youth (mage = 19.3). Interview measures of attenuated psychotic symptoms and self-report measures of psychosis proneness, depression, and anxiety were collected at baseline and 12-month follow-up (n = 70 at follow-up). Factor, cross-sectional, and longitudinal analyses examined relationships between study variables. RESULTS Self-reported PLEs were best represented by the same three factors found in the general population: persecutory ideation, bizarre experiences, and perceptual abnormalities. Cross-sectionally, PLEs-particularly persecutory ideation-correlated with interview-rated attenuated psychotic symptoms and self-reported psychosis proneness, depression, and anxiety. Longitudinally, baseline PLEs trended toward predicting 12-month change in positive attenuated psychotic symptoms (r = .29, pFDR = .058). Incrementally, baseline PLEs predicted 12-month change in positive and disorganized symptoms, when accounting for the effect of baseline positive symptoms and demographics. CONCLUSIONS Three types of PLEs were valid in this CHR sample. Self-reported PLEs may be used not only to screen individuals for inclusion in the CHR classification, but also to characterize individuals within this population. Self-reported PLEs may help to forecast which CHR individuals will progress toward psychotic illness.
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Affiliation(s)
| | - Vijay A. Mittal
- Psychology, Psychiatry, Medical Social Sciences, Institute for Policy Research, Northwestern University, Evanston, IL, USA
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18
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Gupta T, Cowan HR, Strauss GP, Walker EF, Mittal VA. Deconstructing Negative Symptoms in Individuals at Clinical High-Risk for Psychosis: Evidence for Volitional and Diminished Emotionality Subgroups That Predict Clinical Presentation and Functional Outcome. Schizophr Bull 2020; 47:54-63. [PMID: 32955097 PMCID: PMC7825091 DOI: 10.1093/schbul/sbaa084] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 12/16/2022]
Abstract
Negative symptoms are characteristic of schizophrenia and closely linked to numerous outcomes. A body of work has sought to identify homogenous negative symptom subgroups-a strategy that can promote mechanistic understanding and precision medicine. However, our knowledge of negative symptom subgroups among individuals at clinical high-risk (CHR) for psychosis is limited. Here, we investigated distinct negative symptom profiles in a large CHR sample (N = 244) using a cluster analysis approach. Subgroups were compared on external validators that are (1) commonly observed in the schizophrenia literature and/or (2) may be particularly relevant for CHR individuals, informing early prevention and prediction. We observed 4 distinct negative symptom subgroups, including individuals with (1) lower symptom severity, (2) deficits in emotion, (3) impairments in volition, and (4) global elevations. Analyses of external validators suggested a pattern in which individuals with global impairments and volitional deficits exhibited more clinical pathology. Furthermore, the Volition group endorsed more disorganized, anxious, and depressive symptoms and impairments in functioning compared to the Emotion group. These data suggest there are unique negative symptom profiles in CHR individuals, converging with studies in schizophrenia indicating motivational deficits may be central to this symptom dimension. Furthermore, observed differences in CHR relevant external validators may help to inform early identification and treatment efforts.
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Affiliation(s)
- Tina Gupta
- Department of Psychology, Department of Psychiatry, Department of Medical Social Sciences, Institute for Policy Research, Institute for Innovations in Developmental Sciences, Northwestern University, Evanston, IL
- To whom correspondence should be addressed; Department of Psychology, Northwestern University, 2029 Sheridan Road, Evanston, IL 60208, US; tel: 847-467-5907, fax: 847-467-5707, e-mail:
| | - Henry R Cowan
- Department of Psychology, Department of Psychiatry, Department of Medical Social Sciences, Institute for Policy Research, Institute for Innovations in Developmental Sciences, Northwestern University, Evanston, IL
| | | | - Elaine F Walker
- Department of Psychology and Psychiatry, Emory University, Atlanta, GA
| | - Vijay A Mittal
- Department of Psychology, Department of Psychiatry, Department of Medical Social Sciences, Institute for Policy Research, Institute for Innovations in Developmental Sciences, Northwestern University, Evanston, IL
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19
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Cowan HR, Mittal VA, Allen DN, Gold JM, Strauss GP. Heterogeneity of emotional experience in schizophrenia: Trait affect profiles predict clinical presentation and functional outcome. J Abnorm Psychol 2020; 129:760-767. [PMID: 32584084 DOI: 10.1037/abn0000554] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The current study examined whether subgroups of individuals with schizophrenia could be identified based on their profiles of trait positive and negative emotional experience, and whether those subgroups differed in their symptom presentation and functional outcome. Participants included 192 outpatients diagnosed with schizophrenia or schizoaffective disorder (SZ) and 149 demographically matched healthy controls who completed the trait version of the Positive and Negative Affect Scale, as well as symptom and functional outcome assessments. Cluster analysis determined whether patients could be separated into meaningful subgroups based on their trait emotional experience profiles, and discriminant function analysis determined whether these groups were valid and adequately separated. Forty-two percent of the patients fell into an affectively normal cluster, whereas 28% and 30% fell into low positive affect (PA) and high negative affect (NA) clusters, respectively. These subgroups differed significantly on positive symptoms, negative symptoms, Diagnostic and Statistical Manual of Mental Disorders diagnoses, and functional outcomes. Trait emotional experience is heterogeneous in outpatients with psychotic disorders, and meaningful subgroups of patients with different profiles of PA and NA can be identified. These subgroups show meaningful differences in clinical presentation, which may necessitate different treatment approaches. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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21
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Abstract
Schizophrenia researchers may ask themselves-or be asked by others-whether their research is relevant in the face of the COVID-19 pandemic. This letter argues that schizophrenia research is more relevant than ever during this public health crisis, because of the likelihood that the COVID-19 pandemic may lead to increased incidence of psychotic disorders.
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Affiliation(s)
- Henry R Cowan
- Northwestern University, Swift Hall, 2029 Sheridan Road, Evanston, IL 60208, United States of America.
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22
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Ristanovic I, Vargas T, Cowan HR, Mittal VA. Consistent Exposure to Psychosocial Stressors and Progressive Intolerance to Stress in Individuals at Clinical High Risk for Psychosis. Schizophr Bull Open 2020; 1:sgaa004. [PMID: 37601822 PMCID: PMC10438911 DOI: 10.1093/schizbullopen/sgaa004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
A body of evidence suggests that exposure to psychosocial stressors and stress sensitivity are involved in psychosis pathogenesis. However, little is known about the temporal course of these domains in those with psychosis-risk syndromes. Furthermore, to date, there have been no studies examining associations between psychosocial stressors and impaired stress tolerance, or how these factors might be implicated in symptom progression prior to psychosis onset. A total of 73 clinical high-risk (CHR) participants and 78 healthy controls (HCs) completed baseline measures of life event (LE) exposure and impaired stress tolerance. Additionally, 54 CHR and 57 HC participants returned to complete the same procedures at a 12-month follow-up assessment. Results indicated that when compared to HCs, CHR individuals exhibited increased LE exposure and impaired stress tolerance at baseline. Longitudinal analyses compared subgroups of CHR participants who exhibited positive symptoms worsening over the 1-year course (CHR-Prog), improved or steady (CHR-Remiss/Persist), and HCs. CHR-Prog individuals showed consistently elevated independent LEs exposure while CHR-Remiss/Persist reported a decline and HCs a steady low level across time. Furthermore, CHR-Prog exhibited increased stress intolerance, while the CHR-Remiss/Persist improved and HCs displayed consistently low levels over time. Analyses examining interrelationships between these domains showed a trend level interaction effect predicting follow-up symptoms. Taken together, results from the present study indicate an important role for exposure to stressors and increasing stress intolerance during psychosis pathogenesis. Additionally, findings indicating that decreases in stress exposure may lead to more favorable outcomes provide a promising target for novel targeted interventions.
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Affiliation(s)
| | - Teresa Vargas
- Department of Psychology, Northwestern University, Evanston, IL
| | - Henry R. Cowan
- Department of Psychology, Northwestern University, Evanston, IL
| | - Vijay Anand Mittal
- Department of Psychology, Northwestern University, Evanston, IL
- Department of Psychiatry, Northwestern University, Chicago, IL
- Department of Medical Social Sciences, Northwestern University, Chicago, IL
- Institute for Policy Research, Northwestern University, Evanston, IL
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23
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Cowan HR, Mittal VA. Transdiagnostic Dimensions of Psychiatric Comorbidity in Individuals at Clinical High Risk for Psychosis: A Preliminary Study Informed by HiTOP. Front Psychiatry 2020; 11:614710. [PMID: 33488432 PMCID: PMC7819881 DOI: 10.3389/fpsyt.2020.614710] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 10/06/2020] [Accepted: 12/03/2020] [Indexed: 11/18/2022] Open
Abstract
Background: Although psychiatric comorbidity is the norm among individuals at clinical high risk for psychotic disorders (CHR), research has yet to examine transdiagnostic dimensional models of comorbidity in this critical population. Methods: This study analyzed quantitative measures of eleven psychiatric syndromes in a group at CHR (n = 71) and a matched healthy comparison group (n = 73) to determine these syndromes' dimensional structure and relationships to cognition, functioning, and risk of conversion to psychotic disorders. Results: Relative to the comparison group, the CHR group was elevated on all eleven psychiatric syndromes. Exploratory factor analysis found three psychopathology dimensions: internalizing, negative symptoms, and positive symptoms. Depression cross-loaded onto the internalizing and negative symptom dimensions. Hypomania loaded positively on positive symptoms but negatively on negative symptoms. The negative symptom factor was associated with poorer cognition and functioning and a higher risk of conversion to psychosis. Conclusions: These dimensions align with internalizing, detachment, and thought disorder, three of the five spectra in higher-order models such as the Hierarchical Taxonomy of Psychopathology (HiTOP). In the CHR state, detachment appears to be particularly insidious and predictive of psychosis. Further research is required to distinguish depression and hypomania from attenuated psychotic symptoms in this population.
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Affiliation(s)
- Henry R Cowan
- Department of Psychology, Northwestern University, Evanston, IL, United States
| | - Vijay A Mittal
- Department of Psychology, Psychiatry and Medical Social Sciences, Institute for Policy Research, Northwestern University, Evanston, IL, United States
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Cowan HR, Chen X, Jones BK, McAdams DP. The single greatest life challenge: How late-midlife adults construct narratives of significant personal challenges. Journal of Research in Personality 2019. [DOI: 10.1016/j.jrp.2019.103867] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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25
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Damme KSF, Pelletier‐Baldelli A, Cowan HR, Orr JM, Mittal VA. Cover Image. Hum Brain Mapp 2019. [DOI: 10.1002/hbm.24270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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26
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Damme KSF, Pelletier-Baldelli A, Cowan HR, Orr JM, Mittal VA. Distinct and opposite profiles of connectivity during self-reference task and rest in youth at clinical high risk for psychosis. Hum Brain Mapp 2019; 40:3254-3264. [PMID: 30941844 DOI: 10.1002/hbm.24595] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 03/24/2019] [Accepted: 03/26/2019] [Indexed: 11/10/2022] Open
Abstract
Self-reference is impaired in psychotic disorders such as schizophrenia, associated with disability, and closely related to characteristic patterns of aberrant brain connectivity. However, at present, it is unclear whether self-reference is impacted in pathogenesis of the disorder. Alterations in connectivity during a self-reference task or resting-state in the psychosis risk (i.e., prodromal) period may yield important clues for biomarker development, as well as for novel treatment targets. This study examined a task-based and resting-state functional magnetic resonance imaging in individuals at clinical high risk (CHR) for psychosis (n = 22) and healthy control unaffected peers (n = 20). The self-reference task comprised three task conditions where subjects were asked if an adjective was relevant to themselves (self), a designated other individual (other), or to evaluate the word's spelling (letter). Connectivity analyses examined medial prefrontal cortex (mPFC) and posterior cingulate cortex (PCC), regions commonly found in conjunction analyses of self-reference, during both the self-reference task and rest. In task connectivity analyses, CHR individuals exhibited decreased mPFC-PCC connectivity when compared to controls. In resting-state analyses, CHR participants showed greater mPFC-PCC connectivity. Taken together, results suggest that psychosis-like alterations in mPFC-PCC connectivity is present prior to psychosis onset across both task and rest.
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Affiliation(s)
| | | | - Henry R Cowan
- Department of Psychology, Northwestern University, Evanston, Illinois
| | - Joseph M Orr
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, Texas.,Texas A&M Institute for Neuroscience, Texas A&M University, College Station, Texas
| | - Vijay A Mittal
- Department of Psychology, Northwestern University, Evanston, Illinois.,Department of Psychiatry, Northwestern University, Chicago, Illinois.,Medical Social Sciences, Northwestern University, Chicago, Illinois.,Institute for Policy Research (IPR), Northwestern University, Chicago, Illinois.,Institute for Innovations in Developmental Sciences (DevSci), Northwestern University, Evanston, Illinois
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Abstract
Psychological investigations into the structure of well-being have been largely cross-sectional. However, longitudinal models are needed as Western societies work to improve individual well-being. The current multilevel-modeling study examined within-person dynamics of well-being over 8 years. I asked two questions: (a) How do life satisfaction and psychological well-being (measures drawn from two well-being research traditions) relate over time? and (b) do these relationships vary on the basis of individuals' extraversion or neuroticism? Measures of life satisfaction and psychological well-being were collected in 8 consecutive years from 159 American adults in late midlife. A dispositional-life-satisfaction set point and yearly variation in life satisfaction both related to higher yearly psychological well-being. Neuroticism, but not extraversion, predicted a stronger within-person relationship between life satisfaction and psychological well-being. For participants with very low neuroticism, life satisfaction and psychological well-being varied independently. In sum, experiences of life satisfaction and psychological well-being converged for more neurotic individuals and diverged for more emotionally stable participants.
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Kumar MM, Cowan HR, Erdman L, Kaufman M, Hick KM. Reach Out and Read is Feasible and Effective for Adolescent Mothers: A Pilot Study. Matern Child Health J 2015; 20:630-8. [DOI: 10.1007/s10995-015-1862-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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