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1
Burke, Aggrey. "Distinguishing vulnerable clients from psychotic patients with follow-up mortality data." BJPsych Open 7, S1 (June 2021): S11—S12. http://dx.doi.org/10.1192/bjo.2021.90.
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AimsThe aim of the present study is to determine whether vulnerable non-psychotic clients presenting in court proceedings do not share the same mortality profile as psychotic patients in similar environments. It is hypothesised that the two display quite separate mortality profiles.BackgroundThe increased mortality of psychiatric patients and prisoners has been documented but less is known of the outcomes among other vulnerable populations .The population for study is a consecutive series of assessments in court proceedings of carers of children at risk and violent offenders.MethodAssistants not involved in the initial assessments transferred data from case notes and this material was transferred to computer files. Statistical analysis SPSS19Formal psychiatric diagnoses were those agreed in court proceedings. National mortality records were searched and copies of death certificates obtained. A small number of cases known to have returned overseas were excluded. 772 cases were studied. One in five were assessed in prison, twice as many gave a history of violent criminal behaviour. Over a half suffered abuse or neglect or admitted to being unhappy in childhood. Three subgroups have been identified: Vulnerable with no psychotic illness(60%), psychosis with no evidence of personality disorder or of mixed psychosis(18%), linked psychosis(22%). It was found that demographic variables , deprivation factors, adverse childhood experiences and outcomes and clinical variables are in excess among linked psychotics compared with other groups. Linear regression of unnatural death among psychotic patients identifies five risk factors. The distribution of high-risk factors among linked psychosis is more than twice that found in other groups.ResultNatural mortality is most evident among clients suffering from psychosis without personality disorder or mixed disorder.Unnatural mortality is more than 10 times greater among patients with linked psychosis, compared with those with no psychosis and four times greater than other psychoses. Risk factors for unnatural mortality are: physical illness, stressful relationship, violence to self or others, detained and history of behaviour disorder.ConclusionThe findings of the present study demonstrate that vulnerable clients without psychosis are less likely to die by unnatural causes than clients who suffer psychosis coexisting with personality disorder or mixed psychosis. The null hypothesis is upheld. The findings suggest that risk assessment of vulnerable populations should take account of risk factors of unnatural death which have been identified in this study.
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McGorry, Patrick D., and Cristina Mei. "Ultra-high-risk paradigm: lessons learnt and new directions." Evidence Based Mental Health 21, no. 4 (October 24, 2018): 131–33. http://dx.doi.org/10.1136/ebmental-2018-300061.
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Within the embryonic early psychosis field in the early 1990s, the conceptualisation and definition of an at-risk or ultra-high-risk (UHR) mental state for psychosis was a breakthrough which transformed the clinical and research landscape in psychiatry. Twenty-five years later, we have a new evidence base that has illuminated the neurobiology of the onset phase of psychotic disorder, delivered Cochrane level 1 evidence showing that the onset of full-threshold sustained psychotic disorder can be at least delayed, and is paving the way to a new generation of transdiagnostic research. Here, we document the contribution of the UHR approach to understanding the underlying mechanisms of psychosis onset as well as the long-term outcomes. Particularly, we highlight that psychosis onset can be delayed in those meeting UHR criteria and that these criteria have a higher valence for subsequent psychotic disorders and some valence for persistent non-psychotic syndromes. Critiques have helped to identify some of the limitations of this paradigm, which are acknowledged. These include evidence that psychotic disorders can emerge more acutely and from other, as yet undefined, precursor states. Rather than defending, or alternatively questioning the value of, the UHR approach, we propose a broader, transdiagnostic staging model that is consistent with the pluripotent and variably comorbid trajectories for mental disorders. This approach moves beyond psychosis to capture a wider range of subthreshold symptoms and full-threshold disorders, thus enhancing prediction for the emergence and progression of a range of mental disorders, as well as providing new avenues for early intervention and prevention.
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Yun, Yang, Lisa J. Phillips, Sue Cotton, Alison R. Yung, Shona M. Francey, Hok Pan Yuen, and Patrick D. Mcgorry. "Obstetric Complications and Transition to Psychosis in an ‘Ultra’ High Risk Sample." Australian & New Zealand Journal of Psychiatry 39, no. 6 (June 2005): 460–66. http://dx.doi.org/10.1080/j.1440-1614.2005.01604.x.
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Objective: An association between birth and pregnancy complications and the later development of schizophrenia has been described for decades and obstetric complications (OCs) have been proposed as a vulnerability marker for psychosis in line with the neurodevelopmental hypothesis of psychotic disorders. Previous studies of OCs have focused on established schizophrenia. In this study, the association between OCs and the development of psychotic disorder was studied in a group of 74 young people identified as being at very high risk for the first onset of psychosis. Method: The ‘ultra’ high risk (UHR) cohort was identified by the presence of subthreshold psychotic symptoms, or a combination of first-degree relative with a psychotic disorder and recent functional decline. Thirty-eight per cent of the cohort developed an acute psychotic episode over the 12-month period after recruitment. As a component of a larger research study, the level of OCs experienced by the UHR cohort was assessed at intake. Results: Obstetric complicationswere not associated with the later development of psychosis in the UHR group included in this study. Conclusions: This study does not suppor t a role for OCs as a risk factorfor the later development of psychosis; however, we cannot conclude that they should be completely ignored as a candidate risk factor for onset of psychosis. A number of weaknesses of the study suggest that it may be premature to dismiss OCs as a risk factor for the development of psychosis and further research is urged in this area.
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Miller, Patrick, Majella Byrne, Ann Hodges, Stephen M. Lawrie, David G. Cunningham Owens, and Eve C. Johnstone. "Schizotypal components in people at high risk of developing schizophrenia: early findings from the Edinburgh High-Risk Study." British Journal of Psychiatry 180, no. 2 (February 2002): 179–84. http://dx.doi.org/10.1192/bjp.180.2.179.
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BackgroundThe study of high-risk groups and the development of schizophrenia.AimsTo investigate further schizotypy, measured by the Structured Interview for Schizotypy (SIS), and to examine relationships between schizotypal components, psychotic symptoms on the Present State Examination (PSE) and subsequent schizophrenia.MethodThe SIS and PSE were administered on entry. Schizophrenia onsets were recorded during follow-up.ResultsThe SIS yielded four principal components labelled social withdrawal, psychotic symptoms, socio-emotional dysfunction and odd behaviour. On entry, these differentiated between controls, subjects at risk for schizophrenia with and without symptoms and patients with schizophrenia. Seven of 78 subjects at risk developed schizophrenia within 39 months. This was best predicted by combining the four SIS components.ConclusionsSchizotypy is heterogeneous and may become psychosis, particularly if several of its components are present. As psychosis develops, odd behaviour gives way to psychotic symptoms and social function deteriorates.
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Girgis, Ragy R. "The neurobiology of suicide in psychosis: A systematic review." Journal of Psychopharmacology 34, no. 8 (July 8, 2020): 811–19. http://dx.doi.org/10.1177/0269881120936919.
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The lifetime risk of dying by suicide in schizophrenia and related psychoses has been estimated to be approximately between 5% and 7%, though some have estimated that the number is closer to 10%. The highest risk for suicide occurs within the first year after presentation, when patients have a 12 times greater risk of dying by suicide than the general population, or a 60% higher risk compared with patients in other phases of psychosis, although the risk continues for many years. Some 31% of all deaths in first and early episode samples are due to suicide. Studies in individuals at clinical high-risk for psychosis (CHR) or with attenuated positive symptoms also demonstrate that suicidality is common and problematic in these individuals. Therefore, suicide in psychosis is a particularly severe problem. In order to develop interventions aimed at reducing the risk of suicide in psychotic individuals, it will be critical to understand the neurobiology of suicide in psychosis. In this paper, I report on the results of a systematic review of the work done to date on the neurobiology of suicide in psychosis and on suicidality in the CHR period. I will also identify gaps in knowledge and discuss future strategies for studying the neurobiology of suicidality in psychosis that may help to disentangle the links between suicide and psychosis and, by doing so, allow us to gain a greater understanding of the relationship between suicide and psychosis, which is critical for developing interventions aimed at reducing the risk of suicide in psychotic individuals.
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FEARON, PAUL, JAMES B. KIRKBRIDE, CRAIG MORGAN, PAOLA DAZZAN, KEVIN MORGAN, TUHINA LLOYD, GERARD HUTCHINSON, et al. "Incidence of schizophrenia and other psychoses in ethnic minority groups: results from the MRC AESOP Study." Psychological Medicine 36, no. 11 (August 29, 2006): 1541–50. http://dx.doi.org/10.1017/s0033291706008774.
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Background. The incidence of schizophrenia in the African-Caribbean population in England is reported to be raised. We sought to clarify whether (a) the rates of other psychotic disorders are increased, (b) whether psychosis is increased in other ethnic minority groups, and (c) whether particular age or gender groups are especially at risk.Method. We identified all people (n=568) aged 16–64 years presenting to secondary services with their first psychotic symptoms in three well-defined English areas (over a 2-year period in Southeast London and Nottingham and a 9-month period in Bristol). Standardized incidence rates and incidence rate ratios (IRR) for all major psychosis syndromes for all main ethnic groups were calculated.Results. We found remarkably high IRRs for both schizophrenia and manic psychosis in both African-Caribbeans (schizophrenia 9·1, manic psychosis 8·0) and Black Africans (schizophrenia 5·8, manic psychosis 6·2) in men and women. IRRs in other ethnic minority groups were modestly increased as were rates for depressive psychosis and other psychoses in all minority groups. These raised rates were evident in all age groups in our study.Conclusions. Ethnic minority groups are at increased risk for all psychotic illnesses but African-Caribbeans and Black Africans appear to be at especially high risk for both schizophrenia and mania. These findings suggest that (a) either additional risk factors are operating in African-Caribbeans and Black Africans or that these factors are particularly prevalent in these groups, and that (b) such factors increase risk for schizophrenia and mania in these groups.
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Alharbi, F. "A comparison and contrast of cannabis and amphetamine-type stimulant induced psychoses." European Psychiatry 41, S1 (April 2017): s856. http://dx.doi.org/10.1016/j.eurpsy.2017.01.1705.
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BackgroundThe term “psychosis” is very broad. Substance users represent one group with particularly high rates of psychotic symptoms.ObjectiveThis review will present an update on cannabis and amphetamine-type Stimulant (ATS) and will try to differentiate and compare their associated psychotic features.MethodA systematic literature search was conducted from 1980 to date in the following databases: MEDLINE, PsycINFO and PubMed. Articles were included if they were highlighting substances induced psychoses, with particular emphasis on stimulants/amphetamine/methamphetamine and cannabis/marijuana induced psychoses, schizophrenia-spectrum disorder or schizophrenia.ResultsThere are many differences between these two substances regarding source, neurobiological processes, average latency periods before developing psychosis, clinical features as compared to schizophrenia, risk of using drugs and developing psychosis and drugs use and development of schizophrenia and urine screening test. With the recent proposals to regulate cannabis use, a further investigation of the association of this use with psychosis is required.ConclusionsOur search elicited many studies of one substance and its association with psychosis but few comparative studies across substances. Yet in our opinion, these comparisons could shed further insight on the development of psychotic features.Disclosure of interestThe author has not supplied his/her declaration of competing interest.
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Andreou, Christina, Barbara Bailey, and Stefan Borgwardt. "Assessment and treatment of individuals at high risk for psychosis." BJPsych Advances 25, no. 3 (March 6, 2019): 177–84. http://dx.doi.org/10.1192/bja.2019.3.
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SUMMARYEarly detection and specialised early intervention for people at high risk for psychotic disorders have received growing attention in the past few decades, with the aim of delaying or preventing the outbreak of explicit psychotic symptoms and improving functional outcomes. This article summarises criteria for a diagnosis of high psychosis risk, the implications for such a diagnosis and recommendations for treatment.LEARNING OBJECTIVESAfter reading this article you will be able to: •recognise signs and symptoms indicating increased psychosis risk•understand uses and limitations of screening for high psychosis risk, and interpretation of results•recognise evidence-based treatment options for patients at clinical high risk for psychosis.DECLARATION OF INTERESTC.A. has received non-financial support from Sunovion and Lundbeck in the past 36 months.
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McGuire, Philip, Sudhakar Selvaraj, and Oliver Howes. "Is clinical intervention in the ultra high risk phase effective?" Revista Brasileira de Psiquiatria 33, suppl 2 (October 2011): s161—s174. http://dx.doi.org/10.1590/s1516-44462011000600004.
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Recent research suggests that early intervention in psychosis might improve the chances of recovery and may even be able to prevent the onset of psychotic disorders. Clinical intervention in subjects at ultra high risk (UHR) of psychosis can have three different objectives. The first aim is to improve the 'prodromal' symptoms and problems that subjects usually present with. The second is to reduce the risk of the subsequent onset of frank psychosis. The third objective is to minimize the delay before the initiation of antipsychotic treatment in the subgroup of UHR subjects that go on to develop a first episode of psychosis. Both pharmacological and psychological interventions appear to be effective in reducing the severity of presenting symptoms in UHR subjects. Clinical trials of the impact of these interventions on the risk of subsequent transition to psychosis have been positive, but have involved small samples, and thus the issue of whether the effects persist in the long term remains to be determined. The monitoring of UHR subjects for the first signs of frank psychosis is an effective means of reducing the delay between the onset of the first episode and the start of antipsychotic treatment. Follow-up studies are required to test whether the reduction in this delay leads to an improved long term outcome. To date, the majority of the interventions that have been used in UHR subjects, such as case management, antipsychotic medication, and cognitive behavior therapy have previously been employed in patients with established psychosis. However, it is possible that treatments that are not normally used in patients with psychotic disorders may prove effective when applied at this stage.
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Kelleher, I., and M. Cannon. "Psychotic-like experiences in the general population: characterizing a high-risk group for psychosis." Psychological Medicine 41, no. 1 (May 19, 2010): 1–6. http://dx.doi.org/10.1017/s0033291710001005.
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Recent research shows that psychotic symptoms, or psychotic-like experiences (PLEs), are reported not only by psychosis patients but also by healthy members of the general population. Healthy individuals who report these symptoms are considered to represent a non-clinical psychosis phenotype, and have been demonstrated to be at increased risk of schizophrenia-spectrum disorder. Converging research now shows that this non-clinical psychosis phenotype is familial, heritable and covaries with familial schizophrenia-spectrum disorder. A review of the research also shows that the non-clinical phenotype is associated extensively with schizophrenia-related risk factors, including social, environmental, substance use, obstetric, developmental, anatomical, motor, cognitive, linguistic, intellectual and psychopathological risk factors. The criterion and construct validity of the non-clinical psychosis phenotype with schizophrenia demonstrates that it is a valid population in which to study the aetiology of psychosis. Furthermore, it suggests shared genetic variation between the clinical and non-clinical phenotypes. Much remains to be learned about psychosis by broadening the scope of research to include the non-clinical psychosis phenotype.
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Ruas Resende, M. B., F. Agostinho, R. Nogueira, D. Cotovio, F. A. Silva, and R. Lousada. "Ultra-High-Risk that do not transition to psychosis. What happens?" European Psychiatry 67, S1 (April 2024): S737. http://dx.doi.org/10.1192/j.eurpsy.2024.1533.
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IntroductionSpeaking prospectively we use the concept of “at risk mental state” (ARMS) to describe the state in which a person has a heightened risk of developing a psychotic disorder. Young people who are experiencing ARMS can be more precisely defined as being at ultra-high-risk of psychosis using a specific set of criteria known as the UHR criteria.ObjectivesTo clarify the concept of ultra-high-risk individuals and to characterize the clinical and functional characteristics and general psychopathology of those individuals that do not transition to psychosis during the follow-up period.MethodsResearch on UpToDate using the terms “Ultra-High-Risk”; “psychosis”, “transition”.ResultsRecent literature has suggested that less than 30% of those who meet established criteria for being at Clinical-High-Risk of psychosis (CHR-P) go on to develop a psychotic illness. It is therefore of crucial importance and relevance to assess and clarify what happens to high-risk individuals who do not transition to psychosis, who make up the vast majority.One of the most recent studies (NAPLS-2) that encompassed 764 of CHR-P individuals who were followed for 2 years, concluded that 278 did not transition to psychosis during the follow-up period. Three clinical outcomes were recorded: 1 group had experienced a psychopathological remission (39.57%); the other kept symptomatic but not currently meeting criteria for a prodromal risk syndrome (33.45%); the third group had a prodromal progression (26.98%). The study concluded among others that although the remission group had improved social functioning at 2 years compared with the other groups, they were still functioning below the healthy control group.Another meta-analysis that included a total of 2756 CHR-P individuals with a mean duration of follow-up of 30.7 months evaluated several clinical outcomes in CHR-P that didn’t transitioned to psychosis and between CHR-P non-transitioning versus those transitioning to psychosis. It concluded that CHR-P that do not transition to psychosis have an overall improvement of symptoms (APS, negative, depressive) and functioning at follow-up compared to baseline.ConclusionsThe occurrence of a first psychotic episode is often devastating for the patient and their family, especially given its usual onset in adolescence and early adulthood. This is a critical period in the individual’s development as a person, and disorders at this stage can threaten the potential for a productive and inclusive adult life. Studies have suggested that less than 30% of individuals classified as UHR actually develop a psychotic disorder.However, little is known about the individuals belonging to this group who do not transition to psychosis. We therefore consider it is relevant to clarify the clinical and functional outcomes of this group of individuals.Disclosure of InterestNone Declared
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Knopf, Alison. "Self‐harming youth admitted to hospital are high risk for psychosis." Brown University Child and Adolescent Behavior Letter 40, no. 5 (April 2024): 7. http://dx.doi.org/10.1002/cbl.30786.
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That there is a strong relationship between psychosis and self‐harm is not in question. However, most of the research conducted has been on individuals already diagnosed with a psychotic disorder. So researchers wanted to look at whether self‐harm can be a marker for future psychosis.
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Knopf, Alison. "Self‐harming individuals admitted to hospital are high risk for psychosis." Brown University Child & Adolescent Psychopharmacology Update 26, no. 4 (March 12, 2024): 4–5. http://dx.doi.org/10.1002/cpu30852.
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That there is a strong relationship between psychosis and self‐harm is not in question. However, most of the research conducted has been on individuals already diagnosed with a psychotic disorder. So researchers wanted to look at whether self‐harm can be a marker for future psychosis.
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Richter, Anja, Evangelos Vassos, Matthew J. Kempton, Mark van der Gaag, Lieuwe de Haan, Barnaby Nelson, Anita Riecher-Rössler, et al. "S175. CLINICAL OUTCOMES IN PEOPLE AT HIGH RISK FOR PSYCHOSIS RELATED TO INTERACTIONS BETWEEN POLYGENIC RISK SCORES AND CHILDHOOD ADVERSITY." Schizophrenia Bulletin 46, Supplement_1 (April 2020): S104. http://dx.doi.org/10.1093/schbul/sbaa031.241.
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Abstract Background Genetic vulnerability to psychosis is polygenic, involving multiple genes with small individual effects (Psychiatric Genomics Consortium (PGC), 2014). The risk of psychosis is also related to environmental factors, such as childhood trauma (Lardinois et al, 2011). Although the onset of psychosis is thought to result from the interaction of genetic and environmental risk factors (Walker & Diforio, 1997), the extent to which the influence of childhood trauma depends on genetic susceptibility remains unclear. We sought to address this issue in a large prospective study of people at clinical high risk (CHR) for psychosis. These individuals present with psychotic and affective symptoms, and are at increased risk of developing both schizophreniform and affective psychoses. Methods We studied subjects of European ancestry, drawn from EU-GEI, a large multi-centre prospective study of people at CHR for psychosis. At baseline, DNA was obtained from subjects who met the CAARMS criteria for the CHR state (n=266) and healthy controls (HC; n=42). Childhood trauma was assessed using the childhood trauma questionnaire (CTQ), which comprises 5 subdomains: emotional abuse, physical abuse, sexual abuse, physical neglect, and emotional neglect. Polygenic risk scores (PRSs) for schizophrenia (SCZ), bipolar disorder (BD) and major depressive disorder (MDD) were constructed separately, using results from meta-analyses by the corresponding Disorder Working Groups of the PGC. The CHR subjects were clinically monitored for up to 5 years and clinical outcomes were assessed in terms of transition to psychosis (as defined by the CAARMS), remission from the CHR state (subject no longer meets CAARMS inclusion criteria) and level of functioning (GAF Disability Scale). Logistic regression models were used to investigate the association between each PRSs and childhood trauma as predictors of transition and remission, adjusted by population stratification using the first 10 principal components, age, sex and site. All findings are reported at p<0.017, Bonferroni-corrected for the 3 PRSs. Results Within the CHR sample, the onset of psychosis during follow up was related to interactions between the BD PRS and the total childhood trauma score (OR=0.959, 95% CI 0.930–0.988, p=0.006), and between the BD PRS and physical abuse (OR=0.787, 95% CI 0.689–0.900, p<0.001). Remission from the CHR state was related to an interaction between the SCZ PRS and childhood sexual abuse (OR: 1.110, 95% CI 1.004–1.226, p=0.041). Discussion These data indicate that clinical outcomes in CHR subjects are related to interactions between the polygenic risk for psychotic disorders and childhood adversity. The measurement of interactions between genomic and environmental risk factors may help to predict individual outcomes in people at high risk in a clinical setting.
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Day, F., L. Valmaggia, C. Pariante, A. Papadopoulos, I. Papadopoulos, and P. McGuire. "Stress in people at high risk for psychosis." European Psychiatry 26, S2 (March 2011): 2088. http://dx.doi.org/10.1016/s0924-9338(11)73791-9.
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BackgroundStress is a key feature of many aetiological models of psychosis and there is considerable empirical evidence implicating stress in the development of psychosis. This paper investigates the role of psychosocial stress in the onset of psychosis by examining the relationship between current and lifetime exposure to traumatic experiences and psychosocial stressors, HPA axis function, and psychopathology in people at high risk of developing psychosis.MethodsSixty ‘high risk’ (HR) participants were compared with 50 healthy control (HC) participants on measures of exposure to psychosocial stressors. Subgroups of HR and HC participants which provided saliva samples were compared regarding measures of HPA axis function.ResultsHR participants were exposed to greater levels of psychosocial stress than HC participants. Specifically, HR participants were more likely to have been separated from their parents (p = .003), report severe parental antipathy (p = .011), and have been bullied while growing up (p = .024). HR participants experienced greater levels of perceived stress than HC participants (p = .001) and were more likely to have had a negative life event in the previous 6 months (p < .001). Positive correlations were found between current stress and number of life events and attenuated psychotic symptoms (r = .585, p < .001, and r = .384, p = < .001, respectively) in the HR participants.DiscussionThis study shows that people at high risk of developing psychosis experience greater levels of psychosocial stress than matched healthy control participants throughout the lifetime, from early childhood to the present day, and that current stress is strongly associated with psychotic symptomatology.
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Morrison, A. P., R. P. Bentall, P. French, L. Walford, A. Kilcommons, A. Knight, M. Kreutz, and S. W. Lewis. "Randomised controlled trial of early detection and cognitive therapy for preventing transition to psychosis in high-risk individuals." British Journal of Psychiatry 181, S43 (September 2002): s78—s84. http://dx.doi.org/10.1192/bjp.181.43.s78.
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BackgroundThere is interest in the possibility of indicated prevention of psychosis. There is a strong case for using psychological approaches to prevent transition to psychosis in high-risk patients.AimsTo identify individuals at high risk of transition to psychosis, and psychological characteristics relevant to the development of psychosis in this group.MethodThe design of a randomised controlled trial of cognitive therapy for the prevention of psychosis in people at high risk (meeting operational criteria of brief or attenuated psychotic symptoms, or first-degree family history with functional decline) is outlined. The first patients recruited are compared with non-patient samples on cognitive and personality factors; an interim analysis of transition rate is reported.ResultsCases (n=31) were recruited mainly from primary care. Of the 23 high-risk patients monitored for 6–12 months, 5 (22%) made the transition to psychosis. The high-risk group scored significantly higher than non-patients on measures of schizotypy, metacognitive beliefs and dysfunctional self-schemas (sociotropy).ConclusionsThe findings validate the methods of identifying individuals at high risk of experiencing a psychotic episode. Compared with non-patient controls, the cases showed dysfunctional metacognitive beliefs and self-schemas.
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Stowkowy, Jacqueline, Diana O. Perkins, Scott W. Woods, Karissa Nyman, and Jean Addington. "Personal Beliefs about Experiences in those at Clinical High Risk for Psychosis." Behavioural and Cognitive Psychotherapy 43, no. 6 (June 20, 2014): 669–75. http://dx.doi.org/10.1017/s1352465814000307.
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Background: Negative beliefs about illness in early psychosis have been shown to have an unfavourable impact on one's quality of life. A shift of focus in psychosis research has been on the detection of individuals considered to be at clinical high risk (CHR) of developing psychosis. Little is known about the impact that beliefs about psychotic like experiences or attenuated psychotic symptoms may have on CHR individuals. Aim: To explore these beliefs in a large sample of young people at CHR of developing psychosis using the Personal Beliefs about Experiences Questionnaire (PBEQ). Method: Beliefs about unusual experiences were assessed in 153 CHR individuals with the PBEQ. Prodromal symptoms (measured by the SIPS) and depression (measured by the CDSS) were also assessed. Results: In CHR individuals, holding more negative beliefs was associated with increased severity in depression and negative symptoms. Higher scores on suspiciousness were associated with increased negative beliefs, and higher levels of grandiosity were associated with decreased negative beliefs. Those who later transitioned to psychosis agreed significantly more with statements concerning control over experiences (i.e. “my experiences frighten me”, “I find it difficult to cope). Conclusions: The results suggest that targeting negative beliefs and other illness related appraisals is an important objective for intervention strategies.
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Phillips, Lisa J., Christina Curry, Alison R. Yung, Hok Pan Yuen, Steven Adlard, and Patrick D. Mcgorry. "Cannabis Use is Not Associated With the Development of Psychosis in an ‘Ultra’ High-Risk Group." Australian & New Zealand Journal of Psychiatry 36, no. 6 (December 2002): 800–806. http://dx.doi.org/10.1046/j.1440-1614.2002.01089.x.
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Background: The association between cannabis use and the development of a first psychotic episode was studied in a group of 100 young people identified as being at very high risk for the onset of psychosis. Method: The ‘ultra’ high risk cohort was identified by the presence of subthreshold psychotic symptoms, or a combination of first-degree relative with a psychotic disorder and recent functional decline. Thirty-two per cent of the cohort developed an acute psychotic episode over the 12-month period after recruitment. As a component of a larger research study, the level of cannabis use by participants in the year prior to enrolment in the study was assessed at intake. Results: Cannabis use or dependence in the year prior to recruitment to this study was not associated with a heightened risk of developing psychosis over the following 12-month period and therefore did not appear to contribute to the onset of a psychotic disorder. Conclusion: The results of this study suggest that cannabis use may not play an integral role in the development of psychosis in a high-risk group. While this study does not support a role for cannabis in the development of first-episode psychosis, we cannot conclude that cannabis use should be completely ignored as a candidate risk factor for onset of psychosis. A number of weaknesses of the study (the low level of cannabis use in the current sample, the lack of monitoring of cannabis use after intake) suggest that it may be premature to dismiss cannabis use as a risk factor for the development of psychosis and further research is urged in this area.
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Palmier-Claus, J. E., G. Dunn, and S. W. Lewis. "Emotional and symptomatic reactivity to stress in individuals at ultra-high risk of developing psychosis." Psychological Medicine 42, no. 5 (November 9, 2011): 1003–12. http://dx.doi.org/10.1017/s0033291711001929.
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BackgroundThe stress–vulnerability model of psychosis continues to be influential. The aim of this study was to compare emotional and symptomatic responses to stress in individuals at ultra-high risk (UHR) of developing psychosis, in age- and gender-matched healthy controls, and in patients with non-affective psychosis.MethodA total of 27 UHR, 27 psychotic and 27 healthy individuals completed the experience sampling method, an ambulant diary technique, where they were required to fill in self-assessment questions about their emotions, symptoms and perceived stress at semi-random times of the day for 6 days. Quesionnaire and interview assessments were also completed.ResultsMultilevel regression analyses showed that individuals at UHR of developing psychosis reported greater negative emotions in response to stress than the healthy individuals. Against the initial hypotheses, the UHR individuals also experienced greater emotional reactivity to stress when compared with the patient group. No significant differences were observed between the patients and the non-clinical sample. Stress measures significantly predicted the intensity of psychotic symptoms in UHR individuals and patients, but the extent of this did not significantly differ between the groups.ConclusionsIndividuals at UHR of developing psychosis may be particularly sensitive to everyday stressors. This effect may diminish after transition to psychosis is made and in periods of stability. Subtle increases in psychotic phenomena occur in response to stressful events across the continuum of psychosis.
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Abarca, Maximiliano, Humberto Pizarro, Rebeca Nuñez, and Marcelo Arancibia. "Physical exercise as an intervention in people at clinical high-risk for psychosis: A narrative review." Medwave 23, no. 08 (September 15, 2023): e2724-e2724. http://dx.doi.org/10.5867/medwave.2023.08.2724.
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The concept of clinical high risk for psychosis has favored research in the neurobiology of the stages prior to psychosis, as well as in preventive interventions. This group is made up of young people with: (1) psychotic symptoms of less intensity or less frequency during a brief time or having genetic history of psychotic disorders associated to a significant deterioration in functioning. The few existing interventions for this population have a low level of evidence. Physical activity and exercise have been shown to be part of the therapy for multiple psychiatric disorders, while a sedentary lifestyle would be a factor that favors psychosis. Indeed, people in clinical high risk for psychosis present a worse physical condition associated with a greater sedentary lifestyle and unhealthy habits. It has been proposed that exercise generates a positive biological effect on the hippocampus and surrounding areas, regions that would be involved in the pathophysiology of psychosis. Some experimental studies have shown a decrease in psychotic symptoms in patients with clinical high risk for psychosis who have followed physical exercise guidelines, as well as morphofunctional changes in brain structures. Although there are barriers to the implementation of this intervention, it is safe and feasible. It is necessary to conduct a greater number of experimental studies on a larger scale to measure its efficacy, generating scientific evidence that will eventually allow physical exercise to be included in clinical practice guidelines as a systematic recommendation for clinical high risk for psychosis.
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Lam, May M. L., Se-Fong Hung, and Eric Y. H. Chen. "Transition to Psychosis: 6-Month follow-up of a Chinese High-Risk Group in Hong Kong." Australian & New Zealand Journal of Psychiatry 40, no. 5 (May 2006): 414–20. http://dx.doi.org/10.1080/j.1440-1614.2006.01817.x.
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Objectives: The identification of individuals at high risk of becoming psychotic within the near future creates opportunities for early intervention before the onset of psychosis. This study sets out to identify a group of symptomatic young people in a Chinese population with the high likelihood of transition to psychosis within a follow-up period of 6 months, and to determine the rate of transition to psychosis in this group. Method: Symptomatic individuals with a family history of psychotic disorder, subthreshold psychotic symptoms or brief transient psychotic symptoms were identified using the operationalized criteria of an ‘At Risk Mental State’. The individuals were prospectively assessed monthly on a measure of psychopathology for 6 months. Results: Eighteen out of 62 individuals (29%) made the transition to frank psychosis within a 6 month follow-up period, with the majority occurring within 3 months. In addition, significant differences were found in the intake Positive and Negative Syndrome Scale, Comprehensive Assessment of ‘At Risk Mental State’ and Global Assessment of Functioning scores between the group that ultimately became psychotic and the group that did not. Conclusion: The period of the highest risk of transition to psychosis was within the 3 months after the study began. Thus, distressed youths in our outpatient clinic, who meet the high-risk criteria should be monitored most closely in the initial 3 months, particularly those individuals with high levels of psychopathology and functional decline.
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Oliver, Dominic, Thomas J. Reilly, Ottone Baccaredda Boy, Natalia Petros, Cathy Davies, Stefan Borgwardt, Philip McGuire, and Paolo Fusar-Poli. "What Causes the Onset of Psychosis in Individuals at Clinical High Risk? A Meta-analysis of Risk and Protective Factors." Schizophrenia Bulletin 46, no. 1 (June 20, 2019): 110–20. http://dx.doi.org/10.1093/schbul/sbz039.
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AbstractTwenty percent of individuals at clinical high risk for psychosis (CHR-P) develop the disorder within 2 years. Extensive research has explored the factors that differentiate those who develop psychosis and those who do not, but the results are conflicting.The current systematic review and meta-analysis comprehensively addresses the consistency and magnitude of evidence for non-purely genetic risk and protective factors associated with the risk of developing psychosis in CHR-P individuals. Random effects meta-analyses, standardized mean difference (SMD) and odds ratio (OR) were used, in combination with an established stratification of evidence that assesses the association of each factor and the onset of psychotic disorders (from class I, convincing evidence to class IV weak evidence), while controlling for several types of biases.A total of 128 original controlled studies relating to 26 factors were retrieved. No factors showed class I-convincing evidence. Two further factors were associated with class II-highly suggestive evidence: attenuated positive psychotic symptoms (SMD = 0.348, 95% CI: 0.280, 0.415) and global functioning (SMD = −0.291, 95% CI: −0.370, −0.211). There was class III-suggestive evidence for negative psychotic symptoms (SMD = 0.393, 95% CI: 0.317, 0.469). There was either class IV-weak or no evidence for all other factors.Our findings suggest that despite the large number of putative risk factors investigated in the literature, only attenuated positive psychotic symptoms, global functioning, and negative psychotic symptoms show suggestive evidence or greater for association with transition to psychosis. The current findings may inform the refinement of clinical prediction models and precision medicine in this field.
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Ising, H. K., F. Smit, W. Veling, J. Rietdijk, S. Dragt, R. M. C. Klaassen, N. S. P. Savelsberg, et al. "Cost-effectiveness of preventing first-episode psychosis in ultra-high-risk subjects: multi-centre randomized controlled trial." Psychological Medicine 45, no. 7 (October 21, 2014): 1435–46. http://dx.doi.org/10.1017/s0033291714002530.
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BackgroundAlthough there is evidence for the effectiveness of interventions for psychosis among ultra-high-risk (UHR) groups, health economic evaluations are lacking. This study aimed to determine the cost effectiveness and cost–utility of cognitive–behavioural therapy (CBT) to prevent first-episode psychosis.MethodThe Dutch Early Detection and Intervention Evaluation study was a randomized controlled trial of 196 UHR patients with an 18-month follow-up. All participants were treated with routine care (RC) for non-psychotic disorders. The experimental group (n = 95) received add-on CBT to prevent first-episode psychosis. We report the intervention, medical and travel costs, as well as costs arising from loss of productivity. Treatment response was defined as psychosis-free survival and quality-adjusted life years (QALYs) gained.ResultsIn the cost-effectiveness analysis, the proportion of averted psychoses was significantly higher in the CBT condition (89.5% v. 76.2%). CBT showed a 63.7% probability of being more cost effective, because it was less costly than RC by US$844 (£551) per prevented psychosis. In the cost–utility analysis, QALY health gains were slightly higher for CBT than for RC (0.60 v. 0.57) and the CBT intervention had a 52.3% probability of being the superior treatment because, for equal or better QALY gains, the costs of CBT were lower than those of RC.ConclusionsAdd-on preventive CBT for UHR resulted in a significant reduction in the incidence of first psychosis. QALY gains show little difference between the two conditions. The CBT intervention proved to be cost saving.
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Barbato, Mariapaola, David L. Penn, Diana O. Perkins, Scott W. Woods, Lu Liu, and Jean Addington. "Metacognitive Functioning in Individuals at Clinical High Risk for Psychosis." Behavioural and Cognitive Psychotherapy 42, no. 5 (March 21, 2013): 526–34. http://dx.doi.org/10.1017/s1352465813000167.
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Background: Metacognition has been described as the knowledge of our own cognitive processes. Metacognitive deficits are common in schizophrenia, but little is known about metacognition before the onset of full-blown psychosis. Aims: This study aimed to longitudinally characterize metacognition in a sample of individuals at clinical high risk (CHR) for psychosis, and to determine if metacognition was related to later conversion to psychosis. Method: Participants (153 CHR individuals; 68 help seeking controls, HSC) were part of the large multi-site PREDICT study, which sought to determine predictors of conversion to psychosis. They were tested at baseline and 6 months using the Meta-Cognitions Questionnaire (MCQ) that has five sub-scales assessing different domains of metacognition. Results: Results of the mixed-effect models demonstrated significantly poorer scores at baseline for the CHR group compared to the HSC group in Negative beliefs about uncontrollability, Negative beliefs and the overall MCQ score. At the 6-month assessment, no difference was observed in metacognition between the two groups, but both groups showed improvement in metacognition over time. Those who later converted to psychosis had poorer performance on metacognitive beliefs at baseline. Conclusions: A poorer performance in metacognition can be seen as a marker of developing a full blown psychotic illness and confirms the potential value of assessing metacognitive beliefs in individuals vulnerable for psychosis.
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Demjaha, Arsime, Sara Weinstein, Daniel Stahl, Fern Day, Lucia Valmaggia, Grazia Rutigliano, Andrea De Micheli, Paolo Fusar-Poli, and Philip McGuire. "Formal thought disorder in people at ultra-high risk of psychosis." BJPsych Open 3, no. 4 (July 2017): 165–70. http://dx.doi.org/10.1192/bjpo.bp.116.004408.
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BackgroundFormal thought disorder is a cardinal feature of psychosis. However, the extent to which formal thought disorder is evident in ultra-high-risk individuals and whether it is linked to the progression to psychosis remains unclear.AimsExamine the severity of formal thought disorder in ultra-high-risk participants and its association with future psychosis.MethodThe Thought and Language Index (TLI) was used to assess 24 ultra-high-risk participants, 16 people with first-episode psychosis and 13 healthy controls. Ultra-high-risk individuals were followed up for a mean duration of 7 years (s.d.=1.5) to determine the relationship between formal thought disorder at baseline and transition to psychosis.ResultsTLI scores were significantly greater in the ultra-high-risk group compared with the healthy control group (effect size (ES)=1.2), but lower than in people with first-episode psychosis (ES=0.8). Total and negative TLI scores were higher in ultra-high-risk individuals who developed psychosis, but this was not significant. Combining negative TLI scores with attenuated psychotic symptoms and basic symptoms predicted transition to psychosis (P=0.04; ES=1.04).ConclusionsTLI is beneficial in evaluating formal thought disorder in ultra-high-risk participants, and complements existing instruments for the evaluation of psychopathology in this group.
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Yung, Alison R., Lisa J. Phillips, Patrick D. McGorry, Colleen A. McFarlane, Shona Francey, Susan Harrigan, George C. Patton, and Henry J. Jackson. "Prediction of psychosis." British Journal of Psychiatry 172, S33 (June 1998): 14–20. http://dx.doi.org/10.1192/s0007125000297602.
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Background The identification of people at high risk of becoming psychotic within the near future creates opportunities for early intervention prior to the onset of psychosis to prevent or minimise later ill-health. The present study combines current knowledge about risk factors for schizophrenia with our knowledge of psychotic prodromes in an attempt to identify a group particularly vulnerable to impending psychosis. We wanted to identify people with high likelihood of transition to psychosis within a follow-up period of 12 months, and to determine the rate of transition to psychosis in this group.Method Various state and trait risk factors for psychosis were used alone and in combination to operationally define a putatively high-risk group. Operationalised criteria for onset of psychosis were established. The individuals were assessed monthly on measures of psychopathology for six months.Results Eight out of 20 people made the transition to frank psychosis within a six-month follow-up period. Follow-up of this group is still in progress, and the 12 month transition rate might prove to be higher still.Conclusions We have demonstrated that it is possible to identify individuals with a high likelihood of onset of psychosis within a brief follow-up period. This lays the foundation for early treatment in an attempt to prevent, delay or minimise the severity of first onset of schizophrenia.
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Bravve, L. V., and N. V. Zakharova. "COVID-19-Associated Schizophrenia-Like Psychosis." Psikhiatriya 20, no. 4 (January 11, 2023): 44–53. http://dx.doi.org/10.30629/2618-6667-2022-20-4-44-53.
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Background: COVID-19-associated psychoses are psychotic disorders that have developed during a new coronavirus infection. Criteria of these psychoses are the manifestation of psychosis simultaneously with infection with the SARS-CoV-2 virus and the presence of documented COVID-19 disease. Information about these diseases appears as brief reports of mental services or with rare clusters. The need to study COVID-19-associated psychoses is due to the relatively high risk of their development, reaching 2.8%. The aim of study was to analyse the identified cases of COVID-19-associated psychosis in comparison with the results presented in the scientific literature. Patients and methods: 50 cases of COVID-19-associated psychosis were analyzed using a clinical method, taking into account the results of physical examination from April 2020 to September 2021. Results: 27 women and 23 men aged 20 to 57 were examined. Common symptoms were revealed: simultaneously or immediately after infection and identification of the virus against the background of growing anxiety and dissomnia, delusional ideas were formed, which quickly turned into fantastic delusion with disturbing agitation and hallucinations and subsequent marked disorganization of behavior with possible confusion of consciousness at the peak of psychosis. Perceptual deceptions were the most common, auditory hallucinations were the most prevalent, and catatonia was relatively common. The cupping therapy led to reduction of psychotic symptoms, and returned patients to a pre-morbid level of functioning. In most cases, there was a critical resolution of the attack, which probably indicates a favorable outcome of the disorder. Such dynamics is consistent with scientific literature data. Conclusion: the question of the primary or secondary nature of COVID-19-associated psychoses remains unresolved. It is necessary to continue the study of COVID-19-associated psychosis with the identification of risk factors for the development of psychosis, manifestation features, psychopathological picture, outcome options to determine the optimal rehabilitation program.
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Berger, Maximus, Eva Burkhardt, Alison Yung, Barnaby Nelson, Shona Francey, Ashleigh Lin, Stephen Wood, et al. "M22. IGG ANTIBODIES TO TOXOPLASMA GONDII ARE ASSOCIATED WITH INCREASED LONG-TERM RISK FOR PSYCHOSIS IN INDIVIDUALS AT ULTRA-HIGH RISK FOR PSYCHOSIS." Schizophrenia Bulletin 46, Supplement_1 (April 2020): S141—S142. http://dx.doi.org/10.1093/schbul/sbaa030.334.
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Abstract Background The prevalence of antibodies to Toxoplasma gondii, a ubiquitous parasitic protozoan causing the infectious disease toxoplasmosis, is increased in patients with psychotic disorders compared to the general population. We have previously shown that antibody titers for T.gondii correlate with the severity of positive symptoms in young people at ultra-high risk (UHR) for psychosis, suggesting that infection with T. gondii may be relevant to the manifestation of psychosis. However, it is unclear if T. gondii antibodies represent a risk factor for psychosis onset or non-psychotic outcome in UHR individuals. The aim of the present study was to examine whether seropositivity for T.gondii is associated with transition to psychosis and other outcomes in young people at UHR for psychosis. Methods The study sample consisted of 96 individuals at UHR for psychosis who were referred to the Personal Assistance and Crisis Evaluation (PACE) clinic in Melbourne, Australia, between 2001 and 2004, consented to optional blood tests for infectious agents and were followed up for up to 10 years after baseline (median (interquartile range) duration of follow-up: 7.15 (3.14 – 7.72) years). Serum IgG antibodies to six viral and parasitic pathogens (Toxoplasma gondii, Herpes Simplex Virus Type 1 and 2, Cytomegalovirus, Epstein Barr Virus, Varicella-Zoster Virus) were measured at baseline. Outcome measures included transition to psychosis, general psychiatric symptomatology and positive psychotic symptoms (BPRS), negative symptoms (SANS), depressive symptoms (HAM-D), anxiety symptoms (HAM-A) and functioning (SOFAS and GAF). Cox proportional hazards regression and linear regression models were used to examine the associations of seropositivity and antibody titers at baseline and transition to psychosis and other outcomes at follow-up. Results A total of 17 individuals (17.7%) were seropositive for Toxoplasma gondii at baseline. The rate of transition to psychosis was higher among seropositive (35.7%) compared to seronegative participants (14.6%), although this was not statistically significant (p=0.101). Antibody titers (IgG) for Toxoplasma gondii were significantly higher at baseline in participants who later transitioned to psychosis (1.34 ± 1.36 vs. 0.79 ± 0.73, p=0.027). Seropositivity for T.gondii IgG at baseline significantly predicted transition to psychosis within the follow-up duration (hazard ratio [HR]=3.61, 95%CI 1.08 – 12.00, p=0.036). Toxoplasma IgG at baseline were significantly associated with higher BPRS scores at follow-up in participants who were seropositive at baseline (Beta=6.38, 95%CI 0.43 – 12.34, p=0.038). No significant associations were found between antibodies to other pathogens and outcome, or between antibodies to Toxoplasma gondii and any other outcomes. Discussion Our findings suggest that the presence of IgG class antibodies for Toxoplasma gondii is associated with a higher risk for psychosis transition in individuals at UHR for psychosis, but not with risk for other long-term outcomes. These observations provide support for the hypothesis that infection with Toxoplasma gondii may be an environmental risk factor for psychosis and suggest that IgG antibodies for Toxoplasma gondii in individuals at UHR for psychosis have prognostic relevance.
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Yung, Alison R., Patrick D. McGorry, Colleen A. McFarlane, and George C. Patton. "The Pace Clinic: Development of a Clinical Service for Young People at High Risk of Psychosis." Australasian Psychiatry 3, no. 5 (October 1995): 345–49. http://dx.doi.org/10.3109/10398569509085280.
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The Pace Clinic (Personal Assessment And Crisis Evaluation) is a newly established clinic which focuses on adolescents and young adults who are at risk of developing a psychotic disorder in the near future. It aims to assess, manage and prospectively study individuals who may be in the prodromal phase of psychosis. Until now it has not been possible to gain access to large numbers of patients in this pre-psychotic state. This paper describes developments that have allowed this to occur. This Clinic has a potentially important role in research into the aetiology of psychotic disorders, the process of transition from prodromal state to psychosis, and in the development of preventative strategies in psychosis.
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De Micheli, Andrea, Umberto Provenzani, Kamil Krakowski, Dominic Oliver, Stefano Damiani, Natascia Brondino, Philip McGuire, and Paolo Fusar-Poli. "Physical Health and Transition to Psychosis in People at Clinical High Risk." Biomedicines 12, no. 3 (February 26, 2024): 523. http://dx.doi.org/10.3390/biomedicines12030523.
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Background: The clinical high risk for psychosis (CHR-P) construct represents an opportunity for prevention and early intervention in young adults, but the relationship between risk for psychosis and physical health in these patients remains unclear. Methods: We conducted a RECORD-compliant clinical register-based cohort study, selecting the long-term cumulative risk of developing a persistent psychotic disorder as the primary outcome. We investigated associations between primary outcome and physical health data with Electronic Health Records at the South London and Maudsley (SLaM) NHS Trust, UK (January 2013–October 2020). We performed survival analyses using Kaplan-Meier curves, log-rank tests, and Cox proportional hazard models. Results: The database included 137 CHR-P subjects; 21 CHR-P developed psychosis during follow-up, and the cumulative incidence of psychosis risk was 4.9% at 1 year and 56.3% at 7 years. Log-rank tests suggested that psychosis risk might change between different levels of nicotine and alcohol dependence. Kaplan-Meier curve analyses indicated that non-hazardous drinkers may have a lower psychosis risk than non-drinkers. In the Cox proportional hazard model, nicotine dependence presented a hazard ratio of 1.34 (95% CI: 1.1–1.64) (p = 0.01), indicating a 34% increase in psychosis risk for every additional point on the Fagerström Test for Nicotine Dependence. Conclusions: Our findings suggest that a comprehensive assessment of tobacco and alcohol use, diet, and physical activity in CHR-P subjects is key to understanding how physical health contributes to psychosis risk.
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Schultze-Lutter, Frauke, Chantal Michel, Stephan Ruhrmann, and Benno G. Schimmelmann. "Prevalence and clinical relevance of interview-assessed psychosis-risk symptoms in the young adult community." Psychological Medicine 48, no. 7 (September 11, 2017): 1167–78. http://dx.doi.org/10.1017/s0033291717002586.
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AbstractBackgroundAn efficient indicated prevention of psychotic disorders requires valid risk criteria that work in both clinical and community samples. Yet, ultra-high risk and basic symptom criteria were recently recommended for use in clinical samples only. Their use in the community was discouraged for lack of knowledge about their prevalence, clinical relevance and risk factors in non-clinical, community settings when validly assessed with the same instruments used in the clinic.MethodsUsing semi-structured telephone interviews with established psychosis-risk instruments, we studied the prevalence of psychosis-risk symptoms and criteria, their clinical relevance (using presence of a non-psychotic mental disorder or of functional deficits as proxy measures) and their risk factors in a random, representative young adult community sample (N=2683; age 16–40 years; response rate: 63.4%).ResultsThe point-prevalence of psychosis-risk symptoms was 13.8%. As these mostly occurred too infrequent to meet frequency requirements of psychosis-risk criteria, only 2.4% of participants met psychosis-risk criteria. A stepwise relationship underlay the association of ultra-high risk and basic symptoms with proxy measures of clinical relevance, this being most significant when both occurred together. In line with models of their formation, basic symptoms were selectively associated with age, ultra-high risk symptoms with traumatic events and lifetime substance misuse.ConclusionsPsychosis-risk criteria were uncommon, indicating little risk of falsely labelling individuals from the community at-risk for psychosis. Besides, both psychosis-risk symptoms and criteria seem to possess sufficient clinical relevance to warrant their broader attention in clinical practice, especially if ultra-high risk and basic symptoms occur together.
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Fusar-Poli, Paolo, Matteo Rocchetti, Alberto Sardella, Alessia Avila, Martina Brandizzi, Edgardo Caverzasi, Pierluigi Politi, Stephan Ruhrmann, and Philip McGuire. "Disorder, not just state of risk: Meta-analysis of functioning and quality of life in people at high risk of psychosis." British Journal of Psychiatry 207, no. 3 (September 2015): 198–206. http://dx.doi.org/10.1192/bjp.bp.114.157115.
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BackgroundThe nosology of the psychosis high-risk state is controversial. Traditionally conceived as an ‘at risk’ state for the development of psychotic disorders, it is also conceptualised as a clinical syndrome associated with functional impairment.AimsTo investigate meta-analytically the functional status of patients at high clinical risk for psychosis and its association with longitudinal outcomes.MethodThree meta-analyses compared level of functioning (n = 3012) and quality of life (QoL) (n = 945) between a high-risk group, a healthy control group and group with psychosis, and baseline functioning in people in the high-risk group who did or did not have a transition to psychosis at follow-up (n = 654).ResultsPeople at high risk had a large impairment in functioning (P<0.001) and worse QoL (P = 0.001) than the healthy control group, but only small to moderately better functioning (P = 0.012) and similar QoL (P = 0.958) compared with the psychosis group. Among the high-risk group, those who did not develop psychosis reported better functioning (P = 0.001) than those who did.ConclusionsOur results indicate that the high-risk state is characterised by consistent and large impairments of functioning and reduction in QoL similar to those in other coded psychiatric disorders.
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Bartholomeusz, Cali F., Vanessa L. Cropley, Cassandra Wannan, Maria Di Biase, Patrick D. McGorry, and Christos Pantelis. "Structural neuroimaging across early-stage psychosis: Aberrations in neurobiological trajectories and implications for the staging model." Australian & New Zealand Journal of Psychiatry 51, no. 5 (October 12, 2016): 455–76. http://dx.doi.org/10.1177/0004867416670522.
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Objective: This review critically examines the structural neuroimaging evidence in psychotic illness, with a focus on longitudinal imaging across the first-episode psychosis and ultra-high-risk of psychosis illness stages. Methods: A thorough search of the literature involving specifically longitudinal neuroimaging in early illness stages of psychosis was conducted. The evidence supporting abnormalities in brain morphology and altered neurodevelopmental trajectories is discussed in the context of a clinical staging model. Results: In general, grey matter (and, to a lesser extent, white matter) declines across multiple frontal, temporal (especially superior regions), insular and parietal regions during the first episode of psychosis, which has a steeper trajectory than that of age-matched healthy counterparts. Although the ultra-high-risk of psychosis literature is considerably mixed, evidence indicates that certain volumetric structural aberrations predate psychotic illness onset (e.g. prefrontal cortex thinning), while other abnormalities present in ultra-high-risk of psychosis populations are potentially non-psychosis-specific (e.g. hippocampal volume reductions). Conclusion: We highlight the advantages of longitudinal designs, discuss the implications such studies have on clinical staging and provide directions for future research.
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Novak, Keisha, Roman Kotov, and Dan Foti. "3252 Neuroclinical fingerprint of high-risk psychosis." Journal of Clinical and Translational Science 3, s1 (March 2019): 49–50. http://dx.doi.org/10.1017/cts.2019.118.
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OBJECTIVES/SPECIFIC AIMS: The study aims to utilize event-related potentials (ERPs) coupled with observable reports of symptoms to comprehensively understand neurological and symptomatic profile of individuals at risk for developing psychosis. The study is a short-term longitudinal design which allows for examination of course as well as structure of illness. The primary outcome is to map known neuroclinical deficits among individuals with schizophrenia onto a high-risk, non-clinical sample. A secondary aim of the study is to demonstrate prediction of symptom severity over time measured by a combination of ERPs and clinical symptom scores. METHODS/STUDY POPULATION: Recruited participants are pre-screened for eligibility via telephone interview. This process includes administration of Community Assessment of Psychotic Experiences (CAPE), and the Mini International Neuropsychiatric Interview (MINI). During in-person lab assessment, participants provide written informed consent and complete a battery of ERP tasks, semi-structured clinical interviews, and self-report questionnaires that assess for presence and severity of sub-threshold psychotic-like experiences. Six months following the laboratory visit, participants will be provided a link to online questionnaires that were completed during laboratory visit in order to reassess presence and severity. RESULTS/ANTICIPATED RESULTS: The target number of participants included in this study is 60. We hope to recruit individuals who range in symptom severity as measured by CAPE. It is of interest to determine relationship among known deficits in individuals with schizophrenia and individuals exhibiting sub-clinical symptoms of psychosis. Additionally, we plan to examine ERPs and symptoms together as a “profile” of high risk psychosis, yielding more robust information about this population than any one ERP or symptom measure alone. The within subjects design of this study allows for examination of symptom progression and potential prediction of symptoms based on brain activity. Many studies examine only single ERP components thus limiting the ability to draw broader conclusions regarding general cognitive frameworks among populations. We use a combination of well-validated ERPs (i.e. P300, N400, ERN) with behavioral and symptom data in order to predict variation in symptoms over the course of 6 months. The project aims to take a novel approach at identifying high-risk profiles based on neurophysiological and behavioral data and using this as a basis for predicting symptom severity across time. DISCUSSION/SIGNIFICANCE OF IMPACT: Individuals endorsing psychotic-like experiences are at heightened risk for developing a psychotic disorder in the future, and have been linked with similar social, behavioral, and emotional risk factors similar to those of schizophrenia. Subjective data (e.g. self-report, interview) sheds light on important information regarding observable symptom manifestation; however, neural measures can detect relatively subtle deficits in information processing that precede and predict overt symptom onset, which necessitates other important methodological considerations. Specifically, extant literature has shown that quantifiable indices of cognitive deficits may represent a vulnerability to psychosis in high-risk populations, and can be measured using event-related potentials (ERPs). This study integrates a psychophysiological approach by mapping neural deficits from schizophrenia onto a high-risk sample. Many studies examine only single ERP components thus limiting the ability to draw broader conclusions regarding general cognitive frameworks among populations. We use a combination of well-validated ERPs (i.e. P300, N400, ERN) with behavioral and symptom data in order to predict variation in symptoms over the course of 6 months. The project aims to take a novel approach at identifying high-risk profiles based on neurophysiological and behavioral data and using this as a basis for predicting symptom severity across time. We will parse heterogeneity within a high-risk group in order to create innovative profiles and potentially predict variation in course of symptoms. In other words, a “fingerprint” physiologic aberration may be exhibited within high-risk individuals and can be used as biomarkers to identify those at risk even before onset of observable symptoms.
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Morrison, Anthony P., Paul French, Lara Walford, Shôn W. Lewis, Aoiffe Kilcommons, Joanne Green, Sophie Parker, and Richard P. Bentall. "Cognitive therapy for the prevention of psychosis in people at ultra-high risk." British Journal of Psychiatry 185, no. 4 (October 2004): 291–97. http://dx.doi.org/10.1192/bjp.185.4.291.
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BackgroundAdvances in the ability to identify people at high risk of developing psychosis have generated interest in the possibility of preventing psychosis.AimsTo evaluate the efficacy of cognitive therapy for the prevention of transition to psychosis.MethodA randomised controlled trial compared cognitive therapy with treatment as usual in 58 patients at ultra-high risk of developing a first episode of psychosis. Therapy was provided over 6 months, and all patients were monitored on a monthly basis for 12 months.ResultsLogistic regression demonstrated that cognitive therapy significantly reduced the likelihood of making progression to psychosis as defined on the Positive and Negative Syndrome Scale over 12 months. In addition, it significantly reduced the likelihood of being prescribed antipsychotic medication and of meeting criteria for a DSM – IV diagnosis of a psychotic disorder. Analysis of covariance showed that the intervention also significantly improved positive symptoms of psychosis in this population over the 12-month period.ConclusionsCognitive therapy appears to be an acceptable and efficacious intervention for people at high risk of developing psychosis.
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O'Connor, K. "Research in young people at ultra-high risk for psychosis: a review of the current evidence." Irish Journal of Psychological Medicine 30, no. 1 (March 2013): 77–89. http://dx.doi.org/10.1017/ipm.2012.9.
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BackgroundThe past 15 years have seen a growing interest in early intervention and detection of psychosis before the onset of the first episode. Recent proposals to include a psychosis risk syndrome (PRS) in DSM 5 have focused attention on the evidence base achieved to date in this field.AimsThis article aims to (1) review the underlying principles of early identification and intervention during the pre-psychotic phase, (2) summarise the naturalistic follow-up studies conducted to date in this ‘at-risk’ population, (3) discuss the identified clinical risk factors for transition to psychosis, (4) summarise the interventional studies both psychological and pharmacological completed to date and (5) briefly discuss the controversy around the proposed inclusion of the PRS in DSM 5.MethodsElectronic databases EmBase, MedLine and PsychInfo were searched using the keywords ultra-high risk/at-risk mental state/risk syndrome/pre-psychotic/prodrome/prodromal and psychosis/schizophrenia.ResultsThe evidence suggests that it is possible to identify individuals who may be at risk of developing psychosis. Results from intervention studies, mostly involving second-generation antipsychotics and cognitive behavioural therapy, are currently insufficient to make treatment recommendations for this group. The emerging research with regard to possible neuroprotective factors such as omega fatty acids is promising, but will require replication in larger cohorts before it can be recommended.
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Valmaggia, L. R., F. L. Day, C. Jones, S. Bissoli, C. Pugh, D. Hall, S. Bhattacharyya, et al. "Cannabis use and transition to psychosis in people at ultra-high risk." Psychological Medicine 44, no. 12 (February 6, 2014): 2503–12. http://dx.doi.org/10.1017/s0033291714000117.
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BackgroundCannabis use is associated with an increased risk of developing a psychotic disorder but the temporal relationship between cannabis use and onset of illness is unclear. The objective of this study was to assess prospectively the influence of cannabis use on transition to psychosis in people at ultra-high risk (UHR) for the disorder.MethodLifetime and continued cannabis use was assessed in a consecutively ascertained sample of 182 people (104 male, 78 female) at UHR for psychosis. Individuals were then followed clinically for 2 years to determine their clinical outcomes.ResultsLifetime cannabis use was reported by 134 individuals (73.6%). However, most of these individuals had stopped using cannabis before clinical presentation (n = 98, 73.1%), usually because of adverse effects. Among lifetime users, frequent use, early-onset use and continued use after presentation were all associated with an increase in transition to psychosis. Transition to psychosis was highest among those who started using cannabis before the age of 15 years and went on to use frequently (frequent early-onset use: 25%; infrequent or late-onset use: 5%; χ21 = 10.971, p = 0.001). However, within the whole sample, cannabis users were no more likely to develop psychosis than those who had never used cannabis (cannabis use: 12.7%; no use: 18.8%; χ21 = 1.061, p = 0.303).ConclusionsIn people at UHR for psychosis, lifetime cannabis use was common but not related to outcome. Among cannabis users, frequent use, early-onset use and continued use after clinical presentation were associated with transition to psychosis.
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JANSSEN, I., D. VERSMISSEN, J. À. CAMPO, I. MYIN-GERMEYS, J. VAN OS, and L. KRABBENDAM. "Attribution style and psychosis: evidence for an externalizing bias in patients but not in individuals at high risk." Psychological Medicine 36, no. 6 (March 27, 2006): 771–78. http://dx.doi.org/10.1017/s0033291706007422.
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Background. The aims of the study were to investigate whether (i) patients with lifetime presence of non-affective psychosis show an external-personal attribution bias for negative events, (ii) this attribution style can also be detected in first-degree relatives of patients with psychosis and subjects with subclinical psychotic experiences, and (iii) this attribution style is related to the presence of psychotic symptoms, in particular delusions.Method. Participants were 23 patients with lifetime presence of non-affective psychosis, a high- risk group of 36 first-degree relatives of patients with non-affective psychosis, a high-risk group of 31 subjects with subclinical psychotic experiences and 46 normal controls. Attribution style was measured by the Internal, Personal and Situational Attribution Questionnaire. Positive symptoms were assessed with the Present State Examination (PSE) and the Scale for the Assessment of Positive Symptoms (SAPS).Results. Relative to the controls, an externalizing bias was apparent in the patient group (β=0·20, p=0·03) but not in the two high-risk groups. There was a dose–response association between externalizing bias and the delusions subscale of the PSE (relative to lowest level: highest level of delusions: β=0·53, p=0·04; intermediate levels of delusions: β=0·23, p=0·35). No significant differences were found in personalizing bias between the four groups.Conclusions. Patients with psychosis tend to use an externalizing bias in their explanations of negative social events, and this bias is associated with the presence of positive psychotic symptoms, in particular delusions. A deviant attribution style is not part of the vulnerability to psychosis.
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Armando, M., M. Schneider, M. Pontillo, S. Vicari, M. Debbane, F. Schultze-Lutter, and S. Eliez. "Ultra High Risk Status and Transition to Psychosis in 22q11.2 Deletion Syndrome." European Psychiatry 41, S1 (April 2017): S81—S82. http://dx.doi.org/10.1016/j.eurpsy.2017.01.258.
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The 22q11.2 deletion syndrome (22q11DS) is characterized by high rates of psychotic symptoms and schizophrenia, making this condition a promising human model for studying risk factors for psychosis. We explored the predictive value of ultra high-risk (UHR) criteria in a sample of patients with 22q11DS. We also examined the additional contribution of sociodemographic, clinical and cognitive variables to predict transition to psychosis within a mean interval of 32.56176 months after initial assessment. Eighty-nine participants with 22q11DS (age range: 8–30 years; mean: 16.1647) were assessed using the structured interview for psychosis-risk syndromes. Information on axis I diagnoses, internalizing and externalizing symptoms, level of functioning and IQ was also collected. At baseline, 22 (24.7%) participants met UHR criteria. Compared to those without a UHR condition, they had a significantly lower functioning, more frequent anxiety disorders and more severe psychopathology. Transition rate to psychosis was 27.3% in UHR and 4.5% in non-UHR participants. Cox regression analyses revealed that UHR status significantly predicted conversion to psychosis. Baseline level of functioning was the only other additional predictor. This is the first study investigating the predictive value of UHR criteria in 22q11DS. It indicates that the clinical path leading to psychosis is broadly comparable to that observed in other clinical high-risk samples. Nevertheless, the relatively high transition rate in non-UHR individuals suggests that other risk markers should be explored in this population. The role of low functioning as a predictor of transition to psychosis should also be investigated more in depth.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Korkeila, J., R. K. R. Salokangas, M. Heinimaaa, T. Svirskis, T. Laine, S. Ruhrmann, H. von Reventlow, et al. "Physical illnesses, developmental risk factors and psychiatric diagnoses among subjects at risk of psychosis." European Psychiatry 28, no. 3 (September 9, 2011): 135–40. http://dx.doi.org/10.1016/j.eurpsy.2011.06.005.
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AbstractBackgroundSubjects with psychoses have significantly increased rates of physical illnesses, but the nature of the relationship remains largely unknown.Material and methodsThe present study is part of the European Prediction of Psychosis Study (EPOS). Data were collected from 245 help-seeking individuals from six European centers (age 16–35) who met criteria for ultra-high risk of psychosis criteria. This paper seeks to investigate self-reported physical ill health and its associations with psychiatric symptoms and disorders, risk factors, and onset of psychosis during 48 months of follow-up.ResultsIn multivariate analysis, lifetime panic disorder (OR = 2.43, 95%CI: 1.03–5.73), known complications during pregnancy and delivery (OR = 2.81, 95%CI: 1.10–7.15), female gender (OR = 2.88, 95%CI: 1.16–7.17), family history of psychosis (OR = 3.08, 95%CI: 1.18–8.07), and having a relationship (OR = 3.44, 95%CI: 1.33–8.94) were significantly associated with self-reported physician-diagnosed illness. In the Cox proportional hazard model we found no significant differences between those who had undergone a transition to psychosis and those who had not.ConclusionsThe physical health of patients defined to be at ultra-high risk of psychosis seems to be commonly impaired and associated with female gender, marital status, complications during pregnancy and birth, lifetime panic disorder, and genetic risk of psychosis.
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Ambarini, Tri Kurniati, Endang Surjaningrum, and Achmad Chusairi. "BASIC SYMPTOM AND THE PREDICTION OF CLINICAL HIGH RISK ON PSYCHOSIS." JOURNAL OF HEALTHCARE IN DEVELOPING COUNTRIES 1, no. 2 (April 21, 2021): 19–23. http://dx.doi.org/10.26480/jhcdc.02.2021.19.23.
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The possibility of providing interventions before the onset of the acute psychotic phase has become the international community’s focus as an early intervention in this disorder. One criterion that is important to diagnoses a high-risk clinical state on psychosis is an basic symptom. Understanding the basic symptom will increase the understanding of the symptoms in individuals with a high risk of psychosis. This literature review aims to review the basic symptoms and empirical evidence that has been carried out by previous studies that show how basic symptom criteria can predicting a high clinical risk of psychosis. Database search using database system in Pubmed and Proquest for the article year 2000 to 2020. Keyword search for the following terms are (basic symptom) AND (high clinical risk). The pieces are limited to the population of ages 15 – 30 years. For this, database-provided age-limit filters and a filter based on the following search terms will be used: [(young people-related words) OR (young adult-related terms)]. The data extraction results found seven articles out of 128 pieces, excluding 41 full-text articles that were not accessible and 79 articles that were not relevant. The use of basic symptom criteria, including COGNIS and COPER, has been shown to predict future conversion to psychosis with a high sensitivity level, above 0.5 or even 0.98. The COGDIS criteria were able to predict first-episode psychosis. However, some studies suggest an increase in predictive accuracy when using the UHR and COGDIS criteria, while using one of these criteria will increase sensitivity. If early detection can help the seeking population, the onset of psychosis can be delayed.
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Coentre, R., D. Barrocas, I. Chendo, and P. Levy. "First Psychotic Episode and Early Intervention: An Opportunity to Change the Course of the Illness." European Psychiatry 24, S1 (January 2009): 1. http://dx.doi.org/10.1016/s0924-9338(09)71358-6.
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Aims:Early intervention in psychosis constitutes an important opportunity to change the classic limited outcome associated with the patients who suffer of psychotic disease.Methods:Based on literature review the authors analyse the evidence for early intervention in first psychotic episode.Results:The evidence for the effectiveness of interventions in early psychosis can be considered in two stages:1.first stage before the onset of full symptoms of psychosis, in people with high risk of developing psychosis or in the prodrome phase of the illness;2.second stage includes the therapeutic focus on the period after the first psychotic episode, reducing the duration of untreated psychosis (DUP) and ameliorate the recovery.Preventing psychosis by intervene in the prodrome or in people with high risk of developing psychosis remains ethically contentious because of the non-specificity of the symptoms. by the contrary there is evidence that early and specialised intervention in first psychotic episode improves outcome. Besides the controversy of the relation between long DUP and poor outcome, there is agreement that clinicians should identify and treat psychosis early with a great impact in patients and their family's life. Effective care during first psychotic episode includes proactive engagement and initiation of low doses of antipsychotics and psychosocial treatments, aiming for maximal symptomatic and functional recovery and the prevention of relapse.Conclusion:There is evidence that early intervention in first psychotic episode improve clinical effectiveness over standard care. Further studies are important to make evidence more robust.
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Fusar-Poli, Paolo, Stefan Borgwardt, Andreas Bechdolf, Jean Addington, Anita Riecher-Rössler, Frauke Schultze-Lutter, Matcheri Keshavan, et al. "The Psychosis High-Risk State." JAMA Psychiatry 70, no. 1 (January 1, 2013): 107. http://dx.doi.org/10.1001/jamapsychiatry.2013.269.
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Karjula, Salla, Riikka K. Arffman, Laure Morin-Papunen, Stephen Franks, Marjo-Riitta Järvelin, Juha S. Tapanainen, Jouko Miettunen, and Terhi T. Piltonen. "A population-based follow-up study shows high psychosis risk in women with PCOS." Archives of Women's Mental Health 25, no. 2 (November 29, 2021): 301–11. http://dx.doi.org/10.1007/s00737-021-01195-4.
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AbstractPolycystic ovary syndrome (PCOS) is a common endocrine disorder affecting up to 18% of women. Besides metabolic and fertility aspects, attention has lately been directed towards the detrimental effect of PCOS on psychological health. The objective of the study was to investigate whether women with PCOS are at higher risk for psychotic disorders. The study population derives from the Northern Finland Birth Cohort 1966 (N = 5889 women). The women with PCOS were identified by two simple questions on oligo-amenorrhea and hirsutism at age 31. Women reporting both symptoms were considered PCOS (N = 124) and asymptomatic women as controls (N = 2145). The diagnosis of psychosis was traced using multiple national registers up to the year 2016. Symptoms of psychopathology were identified using validated questionnaires at age 31. Women with PCOS showed an increased risk for any psychosis by age 50 (HR [95% CI] 2.99, [1.52–5.82]). Also, the risk for psychosis after age 31 was increased (HR 2.68 [1.21–5.92]). The results did not change after adjusting for parental history of psychosis, nor were they explained by body mass index or hyperandrogenism at adulthood. The scales of psychopathology differed between women with PCOS and non-PCOS controls showing more psychopathologies among the affected women. PCOS cases were found to be at a three-fold risk for psychosis, and they had increased psychopathological symptoms. PCOS should be taken into consideration when treating women in psychiatric care. More studies are required to further assess the relationship between PCOS and psychotic diseases.
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Jarrett, M., L. Valmaggia, J. Parrott, A. Forrester, T. Winton-Brown, H. Maguire, D. Ndegwa, P. McGuire, and T. K. J. Craig. "Prisoners at ultra-high-risk for psychosis: a cross-sectional study." Epidemiology and Psychiatric Sciences 25, no. 2 (March 3, 2015): 150–59. http://dx.doi.org/10.1017/s2045796015000062.
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Background.The definition of ultra-high risk (UHR) for psychosis was derived from community-based help-seeking populations. Prisoners have high rates of psychosis and other severe mental health (MH) problems. They also have high rates of risk factors for psychiatric morbidity and yet they are among the populations who are less likely to seek help in the community. Despite a policy of equivalence of care for individuals in prison there are no early intervention services for psychosis in prisons in the UK. This was a study exploring feasibility of introducing such a service into a local London prison. This paper discusses the differences in MH profile of prisoners who met criteria for at-risk mental state compared with those who did not.Method.A two-stage procedure was used. Participants in a local London prison were routinely screened in the first week of arrival in prison with the Prodrome Questionnaire – Brief Version (PQ-B; Loewyet al.2011). Those that screened positive as well as a small sample of those who screened negative underwent a further semi-structured assessment to see whether they met criteria for UHR state. Data on self-harm and suicide attempt, family psychiatric history, and anxiety and depression was also collected.Results.A total of 891 prisoners were screened, 44% of whom screened positive. A total of 354 underwent second stage assessment, 60 of whom had screened negative. Four groups were identified: those that had no MH problems, a group experiencing First Episode Psychosis, those at UHR of psychosis and a group with other MH problems. The UHR state and Psychotic groups had very similar MH profiles of symptoms and distress. Prisoners with no MH problems were at the other end of the spectrum with few symptoms and little distress. The Other group fell in between this group and the psychotic spectrum group in terms of symptomology and distress.Conclusions.This study is the first to examine risk for psychosis in an adult male prison population. We identified a broad spectrum of MH disorder for which there is little current service provision in prisons. Screening early in the custodial process has the potential to identify unmet MH need and has implications for keeping individuals safe in custody. A long-term strategic approach is required to address MH need in prisons.
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Klosterkötter, J. "High-risk-states for psychoses and schizophrenia." European Psychiatry 26, S2 (March 2011): 2098. http://dx.doi.org/10.1016/s0924-9338(11)73801-9.
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Revision 5 of the diagnostic and statistical manual for mental disorders (DSM-V) has stimulated a debate about the inclusion of a risk for psychosis syndrome in order to facilitate the prevention of psychosis.The presentation critically outlines the course of this debate, focusing particularly on the question of how the inclusion of such a syndrome could be justified in DSM-V and ICD-11.Most participants in the debate have initially opposed the inclusion of a risk for a psychosis syndrome. They justified this dismissive attitude with scientific, clinical and ethical arguments. The predictive power of eligible criteria for first psychotic episodes appeared to be too low. Their use as diagnostic criteria would involve the danger of hastily treating many falsely diagnosed individuals at risk for psychosis with antipsychotics and unjustifiably putting them at risk for side effects. In general, diagnoses should be based on grounds of manifest illnesses and not include at risk states for later diseases.Meanwhile, the understanding, that the risk of disease symptoms already has a pathological significance and therefore requires treatment has by now begun to be accepted. This applies both to the risk symptoms in the early initial prodrome, as well as to the high risk symptoms in the late initial prodrome. It would therefore be reasonable to use these two sets of criteria for the definitional operationalisation of the new diagnostic category in the classification systems. This would allow the continuation of preventive efforts but also the development of evidence-based treatment within standard care.
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Yücel, Murat, Stephen J. Wood, Lisa J. Phillips, Geoffrey W. Stuart, Deidre J. Smith, Alison Yung, Dennis Velakoulis, Patrick D. Mcgorry, and Christos Pantelis. "Morphology of the anterior cingulate cortex in young men at ultra-high risk of developing a psychotic illness." British Journal of Psychiatry 182, no. 6 (June 2003): 518–24. http://dx.doi.org/10.1192/bjp.182.6.518.
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BackgroundThe anterior cingulate cortex (ACC) is consistently implicated in the pathophysiology of schizophrenia, and our own work has identified morphological anomalies in the ACC of people with this disorder.AimsTo examine whether ACC morphological anomalies are present in a group at ultra-high risk of psychosis and whether such anomalies can be used to predict the subsequent development of a psychotic illness.MethodMagnetic resonance imaging of 75 healthy volunteers and 63 people at ultra-high risk of developing a psychotic disorder (all right-handed males) was used to examine ACC sulcal and gyral features.ResultsCompared with the controls, significantly fewer people in the ultra-high risk group had a well-developed left paracingulate sulcus and significantly more had an interrupted left cingulate sulcus. There was no difference between those who did (n=21) and did not (n=42) subsequently develop a psychotic illness.ConclusionsAlthough ACC anomalies are present in young people considered to be at ultra-high risk of psychosis, they do not identify individuals who subsequently make the transition to psychosis.
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Falkenberg, Irina, Huai-Hsuan Tseng, Gemma Modinos, Barbara Wild, Philip McGuire, and Paul Allen. "S150. EMOTIONAL BEHAVIOUR IN HIGH-RISK AND FIRST-EPISODE PSYCHOSIS." Schizophrenia Bulletin 46, Supplement_1 (April 2020): S93. http://dx.doi.org/10.1093/schbul/sbaa031.216.
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Abstract Background Studies indicate that people with schizophrenia and first-episode psychosis experience deficits in their ability to accurately detect and display emotions through facial expressions, and that functioning and symptoms are associated with these deficits. This study aims to examine how emotion recognition and facial emotion expression are related to functioning and symptoms in a sample of individuals at ultra-high risk, first-episode psychosis and healthy controls. Methods During fMRI, we combined the presentation of emotional faces with the instruction to react with facial movements predetermined and assigned. 18 patients with first-episode psychosis (FEP), 18 individuals at ultra high risk of psychosis (UHR) and 22 healthy controls (HCs) were examined while viewing happy, sad, or neutral faces and were instructed to simultaneously move the corners of their mouths either (a). upwards or (b). downwards, or (c). to refrain from movement. The subjects’ facial movements were recorded with an MR-compatible video camera. Results Neurofunctional and behavioral response to emotional faces were measured. Analyses have only recently commenced and are ongoing. Full results of the clinical and functional impact of behavioral and neuroimaging results will be presented at the meeting. Discussion Increased knowledge about abnormalities in emotion recognition and behaviour as well as their neural correlates and their impact on clinical measures and functional outcome can inform the development of novel treatment approaches to improve social skills early in the course of schizophrenia and psychotic disorders.
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Yee, N. "The clinical stages of psychosis among violent and non-violent adult prisoners in Australia." European Psychiatry 66, S1 (March 2023): S432. http://dx.doi.org/10.1192/j.eurpsy.2023.929.
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IntroductionPast research examining the relationship between psychosis and criminality has typically focused on chronic schizophrenia and violence. However, contact with the criminal justice system is not constrained to the most unwell or most violent. The present study is novel as it examines the different clinical stages of psychosis, from the at-risk mental states (ARMS)/Ultra-High Risk (UHR) to the early and chronic psychotic illness phase, across the entire spectrum of criminal offending.ObjectivesThe main study objective is to establish the prevalence of the clinical stages of psychosis among adults entering custody and to examine the sociodemographic and forensic characteristics associated with the different stages of psychosis. A further aim is to examine whether psychosis-spectrum prisoners differ from non-psychotic prison controls across these characteristics.MethodsParticipants consist of unselected 291 adult male and female prisoners entering the largest maximum security reception centres in New South Wales (NSW), Australia. They completed a range of semi-structured questionnaires and adapted mental health screening measures. The Comprehensive Assessment of At Risk Mental States (CAARMS; Yung et al., 2005) was used to ascertain whether participants met the Ultra High Risk (UHR), First Episode of Psychosis (FEP) or Established Psychosis (EP) criteria.ResultsParticipants were 34.25 years old (SD = 10.69) on average and men were significantly older than women (p = 0.035). Among prisoners with a psychosis-spectrum illness (n = 121), the prevalence of UHR was 24%, First Episode Psychosis (FEP) was 6% and established psychosis was 11%. Compared to controls, psychosis spectrum prisoners were found to have higher levels of social disadvantage, psychiatric comorbidities and multiple incarceration episodes. However, psychosis was not associated with a greater risk of violent offending. Implications on the complex illness burden associated with psychosis and the need for early identification and intervention across forensic mental health services will be further discussed.ConclusionsThis study is novel as it examines the full spectrum of psychotic illness across the entire spectrum of criminal offending. The findings support the notion that risk of criminal justice contact and complex illness burden exist across the different clinical stages of psychosis, from the UHR to the early FEP and chronic psychosis stages, for both violent and non-violent offending. Early intervention services must consider how to more effectively identify and intervene to reduce the risk of criminal justice system contact among mentally ill individuals.Disclosure of InterestNone Declared
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van der Steur, Sanne J., Albert Batalla, and Matthijs G. Bossong. "Factors Moderating the Association between Cannabis Use and Psychosis Risk: A Systematic Review." Brain Sciences 10, no. 2 (February 12, 2020): 97. http://dx.doi.org/10.3390/brainsci10020097.
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Increasing evidence indicates a relationship between cannabis use and psychosis risk. Specific factors, such as determinants of cannabis use or the genetic profile of cannabis users, appear to moderate this association. The present systematic review presents a detailed and up-to-date literature overview on factors that influence the relationship between cannabis use and psychosis risk. A systematic search was performed according to the PRISMA guidelines in MEDLINE and Embase, and 56 studies were included. The results show that, in particular, frequent cannabis use, especially daily use, and the consumption of high-potency cannabis are associated with a higher risk of developing psychosis. Moreover, several genotypes moderate the impact of cannabis use on psychosis risk, particularly those involved in the dopamine function, such as AKT1. Finally, cannabis use is associated with an earlier psychosis onset and increased risk of transition in individuals at a clinical high risk of psychosis. These findings indicate that changing cannabis use behavior could be a harm reduction strategy employed to lower the risk of developing psychosis. Future research should aim to further develop specific biomarkers and genetic profiles for psychosis, thereby contributing to the identification of individuals at the highest risk of developing a psychotic disorder.