Academic literature on the topic 'Ultra-high-risk of psychosis'
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Journal articles on the topic "Ultra-high-risk of psychosis"
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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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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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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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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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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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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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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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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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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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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.
Dissertations / Theses on the topic "Ultra-high-risk of psychosis"
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Harvey, L. H. "Profiling ultra high risk for psychosis." Thesis, University College London (University of London), 2015. http://discovery.ucl.ac.uk/1473109/.
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This thesis evaluates the Ultra High Risk (UHR) for Psychosis evidence, and seeks to clarify how research exploring differences demonstrated by cannabis and ketamine users on measures and tasks related to the psychosis prodrome can contribute to understanding the factors involved in this stage. The thesis also examines the literature on cognitive biases and insight in the UHR state, summarising the evidence for measures and tasks which sensitively differentiate the UHR state from other stages of Psychosis development.
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Carney, Rebekah. "The physical health and lifestyle of young people at ultra-high risk for psychosis." Thesis, University of Manchester, 2017. https://www.research.manchester.ac.uk/portal/en/theses/the-physical-health-and-lifestyle-of-young-people-at-ultrahigh-risk-for-psychosis(ff29b990-1aee-4968-9e65-196d11cdae57).html.
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The findings of this PhD provide a significant contribution to early intervention research. The ability to detect those at ultra-high risk for psychosis (UHR) has been made possible in recent years. It is well known that people with serious mental illness have poor physical health, yet prior to this PhD little was known about the physical health of UHR individuals. This PhD explores the physical health and lifestyle of the UHR group, and makes recommendations for the development of a physical health intervention. A range of methods have been used including quantitative and qualitative methods, systematic reviews and meta-analyses, and a clinical audit. Therefore, a multifaceted approach to investigate the physical health and lifestyle of UHR individuals has been taken. Papers 1-3 suggest UHR individuals are more likely to live an unhealthy lifestyle than their peers. This includes lower levels of physical activity, and higher levels of substance use (generally cannabis, tobacco and alcohol). Paper 4 contains a clinical audit showing physical health and lifestyle factors are not monitored routinely in early detection services, despite the UHR phase being an ideal opportunity to intervene. Living an unhealthy lifestyle can have a detrimental effect on physical and mental health. Papers 1-4 emphasise the need to intervene to promote a healthy lifestyle for the UHR group. In line with the Medical Research Guidelines for the development of complex interventions, a theoretical model is applied in Paper 5. The final paper presents a qualitative study with UHR individuals, their parents and clinicians to explore barriers and facilitators to living a healthy lifestyle and inform the development of a physical health intervention. A final evidence synthesis includes recommendations for future work and the clinical implications of this thesis. The findings of this PhD provide an important and timely contribution to early intervention research. Prior to this work, the physical health of UHR individuals had been largely under researched. For the first time, this PhD presents evidence to suggest individuals at ultra-high risk for psychosis experience cardiovascular risk, and there is an opportunity to intervene to promote physical health. Although not all UHR individuals will develop psychosis, many will continue to experience difficulties with their mental health. Given that this group are also more likely to live an unhealthy lifestyle, it is important to take a holistic approach to treating those at imminent risk for psychosis, considering both mental and physical health.
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Tognin, Stefania. "Multi-centre study of neuroanatomical abnormalities in individuals at ultra high risk of psychosis." Thesis, King's College London (University of London), 2015. https://kclpure.kcl.ac.uk/portal/en/theses/multicentre-study-of-neuroanatomical-abnormalities-in-individuals-at-ultra-high-risk-of-psychosis(d47fd621-bc74-4dcc-b633-26b2026321ed).html.
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Individuals experiencing prodromal symptoms of psychosis have a very high risk of developing the disorder ranging from 18%-36% within three years of the first clinical presentation. Currently, it is not possible to predict which individuals will subsequently become psychotic only on the basis of their presenting clinical features. This potentially prevents the selective delivery of specialised clinical interventions to those individuals more likely to develop psychosis, which is desirable, both from an ethical point of view and for a more targeted use of available treatments. Neuroimaging may aid prediction as recent neuroimaging studies suggest that there are neuroanatomical differences in people at ultra high risk (UHR) for psychosis relative to healthy control subjects. Furthermore, within UHR cohorts, those who later develop a psychotic disorder (UHR-T, transition) often show more marked structural alteration than those that do not (UHR-NT, non-transition). However the findings have been inconsistent and this may partly reflect the use of small samples and different analytic methods. The aim of this doctoral project was to assess brain structure in individuals at UHR of psychosis using a larger sample than in previous studies. This was achieved by combining Magnetic Resonance Imaging (MRI) data from four different scanning sites and using a range of different analytic methods including voxel-based morphometry, voxel-based cortical thickness analysis and multivariate machine learning. The use of these methods allowed a comprehensive investigation of neuroanatomical differences in a large cohort and, between UHR-T and UHR-NT cases in terms of i) regional gray matter volume; ii) cortical thickness; and iii) subtle and distributed patterns of gray matter alterations. Findings suggest that there are neuroanatomical abnormalities that precede the emergence of psychosis within a distributed fronto-temporal network. In addition, UHR and healthy controls are distinguishable at the individual level based on information on the gray matter volume, whereas UHR-T and UHR-NT are distinguishable at the individual level using cortical thickness information. Nevertheless, the accuracies reported remain relatively low to be applied in real-world clinical settings. Results from this project contribute to expanding the available knowledge on the UHR population.
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Davies, Rosie. "A qualitative investigation of the family environment in young people at ultra-high risk of psychosis." Thesis, Royal Holloway, University of London, 2013. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.604352.
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Recognition of the negative personal, economic and social consequences of psychosis have led to attempts to identify and intervene with those who are at ultrahigh risk (UHR) of developing psychosis with the aim of improving clinical and functional outcomes. It is important that we understand the processes occurring in this period in order to inform preventative interventions. The importance of the family in psychosis is well established with extensive evidence indicating that families are often adversely affected by caring for a family member with psychosis and that the family can influence the course and outcome of psychosis. The family may be a particularly important influence on the UHR group as they are adolescents and young adults who are likely to be living in the family home. There has however been very little research into the family environment in this group. This study aimed to improve theoretical understanding of the family environment in the UHR group by exploring the experiences of the young people and their family members during this phase. This study used a qualitative design using Grounded Theory methodology. Nine UHR young people and five family members were interviewed about their experiences of their family environment. Analysis of the data produced eight theoretical codes describing the family environment over time. These related to difficult early family experiences, difficulties negotiating life-cycle transitions, lacking a framework to understand the young person's difficulties, reaching a crisis point, reappraising roles and futures, family protecting and constraining the young person and, finally, renegotiating the young person's independence. The data describes the interaction of beliefs and behaviours between these young people and family members and the impact of the stage of psychosis, early family experiences and life-cycle stage on these interactions. The findings have implications for the development of family interventions for the UHR group.
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Mills, John Gregory. "Defining the prevalence of subjects at ultra high risk of developing psychosis in the general population." Thesis, King's College London (University of London), 2014. http://kclpure.kcl.ac.uk/portal/en/theses/defining-the-prevalence-of-subjects-at-ultra-high-risk-of-developing-psychosis-in-the-general-population(cb2265a4-b147-4ec1-9318-03662687628a).html.
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Current understanding of ultra high risk syndromes for psychosis (UHR) has been based almost entirely on studies of clinical help-seeking populations. The current study aimed to estimate what proportion of the community would meet UHR criteria, to assess whether this was associated with a need for care, and to explore how these individuals relate to those in clinical settings. An epidemiological sample of 208 young adults (aged 18 to 35) was interviewed using the CAARMS (for positive and negative symptoms) and the SPI-A (for basic symptoms), along with measures of functioning and general psychopathology. Help-seeking was measured in relation to both clinical and informal sources of help. Comparisons were also made with a clinical UHR sample from the OASIS service in South London. Thirty individuals met symptomatic criteria for an UHR state (14 met CAARMS criteria, 12 met SPI-A criteria, 4 met both), giving an estimated community prevalence of around 13%. Of these, 66% (n = 20) reported an unmet need for care, 52% (n = 15) had sought some form of help and 33% (n = 9) had engaged in clinical help-seeking. Help-seeking and distress were most associated with negative symptoms and least associated with basic symptoms. Nevertheless, these community UHR subjects were less functionally impaired [t(63) = 3.30, p = .003] and had less severe positive [z = -4.21, p < .001], negative [z = -2.63, p = .017] and general psychopathology [z = -2.74, p = .019] than those already attending clinical services. Results suggest that the UHR criteria can identify something clinically meaningful even in the general population, and that there may currently be individuals who would benefit from outreach by existing UHR services. However, results also suggest that the current focus on positive symptoms may be insufficient for identifying those in need of care.
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Wigman, Johanna T. W., Nierop Martine van, Wilma A. M. Vollebergh, Roselind Lieb, Katja Beesdo-Baum, Hans-Ulrich Wittchen, and Os Jim van. "Evidence That Psychotic Symptoms Are Prevalent in Disorders of Anxiety and Depression, Impacting on Illness Onset, Risk, and Severity – Implications for Diagnosis and Ultra-High Risk Research." Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2013. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-129460.
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Background: It is commonly assumed that there are clear lines of demarcation between anxiety and depressive disorders on the one hand and psychosis on the other. Recent evidence, however, suggests that this principle may be in need of updating. Methods: Depressive and/or anxiety disorders, with no previous history of psychotic disorder, were examined for the presence of psychotic symptoms in a representative community sample of adolescents and young adults (Early Developmental Stages of Psychopathology study; n=3021). Associations and consequences of psychotic symptomatology in the course of these disorders were examined in terms of demographic distribution, illness severity, onset of service use, and risk factors. Results: Around 27% of those with disorders of anxiety and depression displayed one or more psychotic symptoms, vs 14% in those without these disorders (OR 2.23, 95% CI 1.89–2.66, P < .001). Presence as compared with nonpresence of psychotic symptomatology was associated with younger age (P < .0001), male sex (P < .0058), and poorer illness course (P < .0002). In addition, there was greater persistence of schizotypal (P < .0001) and negative symptoms (P < .0170), more observable illness behavior (P < .0001), greater likelihood of service use (P < .0069), as well as more evidence of familial liability for mental illness (P < .0100), exposure to trauma (P < .0150), recent and more distant life events (P < .0006–.0244), cannabis use (P < .0009), and any drug use (P < .0008). Conclusion: Copresence of psychotic symptomatology in disorders of anxiety and depression is common and a functionally and etiologically highly relevant feature, reinforcing the view that psychopathology is represented by a network or overlapping and reciprocally impacting dimensional liabilities.
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Wigman, Johanna T. W., Nierop Martine van, Wilma A. M. Vollebergh, Roselind Lieb, Katja Beesdo-Baum, Hans-Ulrich Wittchen, and Os Jim van. "Evidence That Psychotic Symptoms Are Prevalent in Disorders of Anxiety and Depression, Impacting on Illness Onset, Risk, and Severity – Implications for Diagnosis and Ultra-High Risk Research." Technische Universität Dresden, 2012. https://tud.qucosa.de/id/qucosa%3A27328.
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Background: It is commonly assumed that there are clear lines of demarcation between anxiety and depressive disorders on the one hand and psychosis on the other. Recent evidence, however, suggests that this principle may be in need of updating. Methods: Depressive and/or anxiety disorders, with no previous history of psychotic disorder, were examined for the presence of psychotic symptoms in a representative community sample of adolescents and young adults (Early Developmental Stages of Psychopathology study; n=3021). Associations and consequences of psychotic symptomatology in the course of these disorders were examined in terms of demographic distribution, illness severity, onset of service use, and risk factors. Results: Around 27% of those with disorders of anxiety and depression displayed one or more psychotic symptoms, vs 14% in those without these disorders (OR 2.23, 95% CI 1.89–2.66, P < .001). Presence as compared with nonpresence of psychotic symptomatology was associated with younger age (P < .0001), male sex (P < .0058), and poorer illness course (P < .0002). In addition, there was greater persistence of schizotypal (P < .0001) and negative symptoms (P < .0170), more observable illness behavior (P < .0001), greater likelihood of service use (P < .0069), as well as more evidence of familial liability for mental illness (P < .0100), exposure to trauma (P < .0150), recent and more distant life events (P < .0006–.0244), cannabis use (P < .0009), and any drug use (P < .0008). Conclusion: Copresence of psychotic symptomatology in disorders of anxiety and depression is common and a functionally and etiologically highly relevant feature, reinforcing the view that psychopathology is represented by a network or overlapping and reciprocally impacting dimensional liabilities.
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Tseng, Huai-Hsuan. "Multisensory emotional recognition and integration in the ultra high risk state and early phase of psychosis : an fMRI study." Thesis, King's College London (University of London), 2014. https://kclpure.kcl.ac.uk/portal/en/theses/multisensory-emotional-recognition-and-integration-in-the-ultra-high-risk-state-and-early-phase-of-psychosis(b16a17f1-44c7-485b-bbae-02b6168286d5).html.
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Patients in the early phase of psychosis show impairments of emotional processing. These patients also demonstrate neuroanatomical and neurofunctional abnormalities which are similar to those in patients with schizophrenia in regions that are involved in emotional processing. Impaired emotional processing is reported, albeit in an attenuated form, in individuals with an Ultra High Risk (UHR) for psychosis. To date however, few studies have specifically examined the neural substrate of emotional processing in the early and prodromal phase of psychosis. The effective integration of emotional information is extremely important for interpersonal interactions and daily social functioning; but the disturbances of integration of multisensory emotional information and the associated neural processes in patients with the early phase of psychosis remain unclear. Moreover, there are no studies that have examined the integration of emotional information in the early and prodromal phase of psychosis. To do this I developed a Multisensory Emotion Recognition and Integration Task (MERIT). In an fMRI experiment and examined the neural substrate for emotion recognition and multisensory integration and the possible alteration in sixteen UHR subjects and eighteen patients with first episode of psychosis (FEP), in contrast with twenty-one healthy controls (HC). FEP patients demonstrated impairments in both unisensory and multisensory emotion recognition, and reduced activation in the brain areas associated with emotional recognition. In UHR subjects, such alterations were less pronounced than in FEP patients. Both FEP and UHR groups did not show a significant alteration in the brain areas associated with integration, but FEP patients failed to deactivate areas that may have been associated with irrelevant visual stimuli, and areas associated with the default mode brain network. A speculative model proposes that the posterior superior temporal area is important for integrating emotional information, and its activation can be modulated by modality-specific attention. These results are in part consistent with the notion that, relative to HCs, FEP patients show neurofunctional alterations in emotional processing regions that are qualitatively similar to those previously observed in schizophrenia patients. UHR subjects showed altered behavioural performance and brain activation at an intermediate level between those in HC and FEP groups. This raises the possibility of establishing neurofunctional biomarkers for emotional processing that could be used to identify UHR subjects who have a higher risk of frank psychosis, a prospect which could be investigated in future prospective and longitudinal studies.
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Åmlid, Håkon Olav. "We Need to Talk: A Qualitative Inquiry into Pathways to Care for Young Men at Ultra-High Risk for Psychosis." Thesis, Örebro universitet, Institutionen för juridik, psykologi och socialt arbete, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-92706.
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A modern conceptualization of psychotic disorders is as neurodevelopmental disorders, with different stages characterized by discrete clusters of symptoms. This conceptualization includes a stage of pre-psychotic prodrome, a target of contemporary research as an attempt to intervene before the development of psychosis. However, these at-risk individuals rarely present to the mental health services before transitioning into psychosis, even more so for male patients. In this study, a method of inductive thematic analysis has been employed to inquire into the pathways to care for young men at Ultra-High Risk (UHR) for psychosis to gain knowledge of- and generate hypotheses about pathways to care for this group. Data was collected using semi-structured interviews (n = 9) over video conference or telephone. Three core-themes were developed as “Willingness to Disclose Distress”, “The Gatekeeping Confidant”, and “The Boiler”, with “Openness” as a core organizing category permeating the core-themes. Together, the themes represent findings on both the importance of relations in help-seeking, as well as how the young men commonly employ non-disclosure, and how this lack of openness delays pathways to care, often resulting in adversities for the participants. Findings provide implications for further inquiry into how to increase the likelihood of young men to disclose distress, as well as providing additional rationale for the development of Mental Health Literacy in the public to make peers as well as participants more able to recognize symptoms of the pre-psychotic prodrome, when, where and how to seek help.
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Pira, Shamira. "The association between the cortisol awakening response (CAR) and neurocognitive impairments in first episode psychosis patients and ultra high-risk individuals." Thesis, McGill University, 2013. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=116933.
Full textAbstract:
Background: Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis has been observed in psychotic disorders. Abnormal levels of the HPA axis hormone, cortisol, are associated with various cognitive processes and cognitive deficits are a key feature of psychosis. The cortisol awakening response (CAR) has been shown to be abnormal in first episode psychosis (FEP) patients but has not been explored in individuals at ultra high-risk (UHR) for developing psychosis. Objectives: The objectives of the following set of studies were to examine the relationship between the CAR and cognitive function in FEP patients and in UHR individuals. In addition, based on established sex differences in both HPA axis activity and psychosis, the effect of sex on this relationship was also explored. Methods: Eighty-two FEP patients, 28 individuals at UHR for psychosis, and 31 community controls were recruited to participate in the two studies. Saliva samples were collected to assess the CAR and a neuropsychological battery was administered to determine performance on six cognitive domains. From these, a global cognition score was also calculated. Results: FEP patients, but not UHR individuals, had a blunted CAR compared to controls and male FEP patients had a more blunted CAR than female FEP patients. A more blunted CAR was associated with a more severe deficit in verbal memory and a lower global cognition score only in female FEP patients. Conclusion: The results suggest that although UHR individuals show deficits in certain cognitive domains, the CAR remains in tact, and there is no association between the two. However, a blunted CAR plays a role in cognitive function for female FEP patients. This may have implications for time and gender specific interventions aimed at stabilizing HPA axis activity.Contexte: La dérégulation de l'axe hypothalamo-hypophyso-surrénalien (HHS) a été observée dans les troubles psychotiques. Des niveaux anormaux de cortisol, une des hormones de l'axe HHS, sont associés à divers processus cognitifs et les déficits cognitifs sont un élément clé de la psychose. Des études démontrent que la sécrétion de cortisol au réveil (SCR) est anormale dans le premier épisode psychotique (PEP) des patients, mais n'a pas été explorée chez les personnes à très haut risque (THR) de déveloper une épisode de psychose. Objectifs: Les objectifs de ces diverses études étaient d'examiner la relation entre la SCR et la fonction cognitive chez les patients PEP et chez les personnes THR. En dépit des différences de sexe connues sur l'axe HPA et la psychose, l'effet du sexe sur cette relation n'a pas été étudié. Méthodes: Quatre-vingt-deux patients PEP, 28 individus à THR pour la psychose, et 31 contrôles communautaires ont été recrutés pour participer dans les deux études. Des échantillons de salive ont été prélevés pour évaluer la SCR et une batterie de tests neuropsychologiques a été administrée pour déterminer les performances sur six domaines cognitifs. De ceux-ci, un résultat cognitif global a également été calculé. Résultats: Les patients PEP, mais pas les individus THR, avaient une SCR atténuée par rapport aux témoins contrôles et les patients masculins PEP avait une SCR plus atténuée que les patients PEP féminin. Une SCR plus atténuée a été associée à un déficit plus sévère de la mémoire verbale et un résultat inférieur de la cognition globale uniquement chez les patients PEP féminins. Conclusion: Bien que les individus THR présentent des déficits dans certains domaines cognitifs, les résultats montrent que la SCR reste intacte et qu'il n'y a aucun lien entre les deux. Toutefois, une SCR atténuée joue un rôle dans la fonction cognitive chez les patients PEP féminins. Cela peut avoir des implications pour les interventions spécifiques au sexe et au temps visant à stabiliser l'activité de l'axe HHS.
Book chapters on the topic "Ultra-high-risk of psychosis"
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Carney, Rebekah, and Joseph Firth. "Physical Health of Young People at High/Ultra-High Risk for Psychosis." In Health Promotion and Wellbeing in People with Mental Health Problems, 59–74. 1 Oliver’s Yard, 55 City Road London EC1Y 1SP: SAGE Publications Ltd, 2017. http://dx.doi.org/10.4135/9781529714746.n5.
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Schultze-Lutter, Frauke. "Detecting the first signs of emerging psychosis." In Early Intervention in Psychiatric Disorders Across Cultures, 57–72. Oxford University Press, 2019. http://dx.doi.org/10.1093/med/9780198820833.003.0006.
Full textAbstract:
Psychotic disorders are costly and debilitating illnesses. Their prodromal phase usually lasts several years and offers opportunities for indicated prevention. Currently, two risk-detection approaches, developed in adult samples, are typically followed: ultra-high risk (UHR) criteria, developed to predict first-episode psychoses within 12 months; and basic symptom (BS) criteria, aimed at the earliest possible detection of emerging psychoses. The main UHR criterion is defined by attenuated psychotic symptoms, which resemble positive symptoms of psychosis except that some insight into their abnormal nature remains. In contrast, BS criteria include subtle disturbances in information processing, experienced immediately with full insight. Various studies have indicated that using a combination of both approaches might increase sensitivity and support the development of a timely, change-sensitive, and stratified risk-detection method. However, since age might play an important role, both the UHR and BS approach might be less psychosis-predictive and less clinically relevant in children and adolescents.
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Bora, Emre, Mahesh Jayaram, and Christos Pantelis. "Prevention and early intervention in psychotic disorders." In New Oxford Textbook of Psychiatry, edited by John R. Geddes, Nancy C. Andreasen, and Guy M. Goodwin, 628–38. Oxford University Press, 2020. http://dx.doi.org/10.1093/med/9780198713005.003.0063.
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This chapter considers treatment approaches in early psychosis and the possibility of prevention prior to the development of illness. The chapter first considers the various definitions of the pre-psychotic state, including prodrome, and the concept of clinical high-risk (CHR) groups. The CHR groups, including the ultra-high-risk (UHR) and basic symptoms (BS) groups aim to identify individuals at imminent risk of transitioning to full-blown psychosis. Further, the chapter summarizes the notion of a staging model for psychosis, which incorporates these earliest pre-psychosis stages, and considers the onset and progression of the illness to chronicity, with differing intervention options for each stage. The relevance of interventions targeting non-specific risk factors, such as trauma, stress, bullying, drug abuse, and migration, in the early years is considered. The chapter discusses possible interventions to prevent or delay psychosis onset or progression (for example, prenatal choline or vitamin D), and public health measures at the population level. It also explores the issues relating to drug prescribing in the pre-psychosis stage and outlines controversies regarding the risk–benefit ratio and ethics of these pre-emptive strategies. Models of care aimed to reduce the duration of untreated psychosis may prove useful. Integrative treatment in early psychosis has been more successful than ‘treatment as usual’ in reducing symptoms, relapse rates, and improving engagement. Early detection and intervention services and public awareness campaigns are key to primary prevention. Studies that investigate trajectories of symptom development and emergence of psychosis are needed, in order to evaluate the effectiveness of pre-emptive and later interventions.
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O'Donoghue, Brian, Meredith McHugh, Barnaby Nelson, and Patrick McGorry. "Effects of Cannabis Use in Those at Ultra-High Risk for Psychosis." In The Complex Connection Between Cannabis and Schizophrenia, 167–81. Elsevier, 2018. http://dx.doi.org/10.1016/b978-0-12-804791-0.00007-0.
Full textConference papers on the topic "Ultra-high-risk of psychosis"
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Aguiar, Ana Paula, Renato Stucki, Graccielle Azevedo, and André Zugman. "TRANSLATION AND TRANSCULTURAL ADAPTATION OF TWO SELF-APPLICABLE QUESTIONNAIRES FOR SCREENING OF ULTRA-HIGH RISK FOR PSYCHOSIS PATIENTS: PQ-16 AND PRIME." In IV International Symposium Adolescence(s) and II Education Forum. Universidade Federal de São Paulo, 2018. http://dx.doi.org/10.22388/2525-5894.2018.0026.
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