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Artigos de revistas sobre o assunto "High-Risk for psychosis"
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Burke, Aggrey. "Distinguishing vulnerable clients from psychotic patients with follow-up mortality data". BJPsych Open 7, S1 (junho de 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., e Cristina Mei. "Ultra-high-risk paradigm: lessons learnt and new directions". Evidence Based Mental Health 21, n.º 4 (24 de outubro de 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 e Patrick D. Mcgorry. "Obstetric Complications and Transition to Psychosis in an ‘Ultra’ High Risk Sample". Australian & New Zealand Journal of Psychiatry 39, n.º 6 (junho de 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 e 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, n.º 2 (fevereiro de 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, n.º 8 (8 de julho de 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, n.º 11 (29 de agosto de 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 (abril de 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 e Stefan Borgwardt. "Assessment and treatment of individuals at high risk for psychosis". BJPsych Advances 25, n.º 3 (6 de março de 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 e Oliver Howes. "Is clinical intervention in the ultra high risk phase effective?" Revista Brasileira de Psiquiatria 33, suppl 2 (outubro de 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., e M. Cannon. "Psychotic-like experiences in the general population: characterizing a high-risk group for psychosis". Psychological Medicine 41, n.º 1 (19 de maio de 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.
Teses / dissertações sobre o assunto "High-Risk for 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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Bois, Catherine. "Investigation in the relationship between childhood adversity and cognitive function in psychosis and individuals at clinical high risk of psychosis". Thesis, University of Edinburgh, 2018. http://hdl.handle.net/1842/33089.
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Background An increasing body of research is suggesting that childhood trauma and adversity may be associated with various adverse mental health outcomes, including psychosis. Cognitive functioning is often compromised in psychosis, and research has shown that there may be a link between early trauma and cognitive impairment in people with psychosis. No systematic review of the literature of this link has been undertaken, and very few studies have examined samples of individuals at high clinical risk for psychosis, to assess whether the potential link between adversity and cognitive functioning exists, without the confounding factors of length of illness, antipsychotic medication and chronicity of symptoms. Method The systematic review of all relevant electronic databases investigates the research to date on the association between childhood adverse experiences and cognitive ability in psychosis, and the conclusions that can be drawn from the existing literature, taking into account relevant considerations regarding sample, methodology and statistical analysis. The subsequent empirical study utilizes a sample at clinical high risk of developing psychosis, and a healthy control group to investigate whether any putative association in specific domains of cognitive functioning, or global cognitive ability and childhood adversity exist in those at clinical high risk, compared to controls. Results The systematic review indicated that at present, the literature looking into childhood adversity and cognitive ability in relation to psychosis is heterogeneous, with some studies finding that this association only occurs in patients, whilst others suggest it only occurs in the control groups. Some studies found it to be specific to certain cognitive domains, whilst others suggest it was a more global impairment. Methodology, samples and analysis differed considerably across studies, and likely contribute to the heterogeneity of the literature. The empirical paper showed a significant interaction effect between group (high risk versus controls) in the high childhood adversity group, in relation to global cognitive ability. Interestingly, this was not related to psychotic symptom severity or distress. Conclusion Several limitations of the existing studies limit the conclusions that can be drawn from the existing evidence regarding the link between childhood adversity and cognitive ability, and future research in prodromal samples is essential. The empirical study showed that there is a link between childhood adversity and cognitive ability in those at clinical high risk of developing psychosis, before disorder onset, that is not present in controls. This suggests that this may form a vulnerability in those at high risk for psychosis, rather than a more general mechanism present in the typical population.
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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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Wigman, Johanna T. W., Nierop Martine van, Wilma A. M. Vollebergh, Roselind Lieb, Katja Beesdo-Baum, Hans-Ulrich Wittchen e 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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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 e 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.
Texto completo da fonteResumo:
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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Chaumette, Boris. "Identification de facteurs biologiques de la transition psychotique". Thesis, Sorbonne Paris Cité, 2016. http://www.theses.fr/2016USPCB046/document.
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La psychose est un syndrome apparaissant progressivement à l’adolescence chez des individus à risque selon un processus dynamique appelé transition psychotique. Ces individus à risque sont repérables cliniquement mais les données biologiques actuelles sont insuffisantes pour expliquer l’apparition de la psychose. Au cours de cette thèse, nous avons cherché à identifier les facteurs biologiques responsables de ce processus. Les hypothèses permettant d’expliquer la transition psychotique privilégient l’interaction gène x environnement, sous-tendue par des mécanismes épigénétiques. Nous avons mené une étude des modifications de la méthylation de l’ADN et de la transcription à l’aide de techniques de biologie moléculaire et de bio-informatique à l’échelle pan-génomique. La transition psychotique semble être liée à des modifications de méthylation et de transcription de gènes impliqués dans des mécanismes comme le guidage axonal ou la régulation du stress oxydatif. Ces modifications longitudinales pourraient refléter l’influence de l’environnement. Les facteurs environnementaux pourraient déréguler l’axe biologique du stress dès les phases précoces de la maladie, comme le suggère l’augmentation de la sécrétion de cortisol basal que nous avons montré chez les individus à risque. En outre, il est probable que des spécificités au niveau des gènes et des processus régulant l’épigénome soient également impliquées dans cette réponse individuelle à l’environnement. Nous avons montré l’importance du métabolisme mono-carboné au moins dans un sous-groupe spécifique de patients. Ces résultats doivent être répliqués et étendus dans d’autres paradigmes pour valider l’implication de ces processus dans la transition psychotique. En cas de confirmation, ces voies biologiques pourraient s’avérer être des pistes intéressantes pour développer des thérapeutiques ciblées et relever le défi de la prévention de la psychose chez des individus à risquePsychosis is a progressive mental disorder which normally occurs during adolescence in at-risk subjects following a dynamic process termed “psychotic transition”. These at-risk subjects are clinically identifiable but biological data are still insufficient in explaining the onset of psychosis. Throughout this thesis, we aim to identify biological factors implicated in this pathophysiological process. Current hypotheses explaining the psychotic transition favor the interaction between genes and the environment mediated by epigenetic mechanisms. We conducted studies examining methylomic and transcriptomic changes during psychotic transition using molecular biology and bioinformatics techniques at a whole genome scale. Our results suggest that psychotic transition may be linked to methylomic and transcriptomic changes in genes implicated in axon guidance or oxidative stress. These longitudinal changes could be related to environmental factors. Some of these factors could deregulate the hormonal stress response at the earliest phases of psychosis. Indeed, our results show that secretion of basal cortisol is increased in prodromal individuals. Moreover, it is likely that genes and processes regulating epigenetic modifications are also implicated in the individual response to the environment. We have shown the importance of the one-carbon metabolism for at least one sub-group of patients affected by psychosis. Our results should be replicated using other paradigms in order to definitively validate the implication of these various actors in the psychotic transition. If confirmed, knowledge of these biological mechanisms could lead to the development of targeted therapeutics to prevent psychosis in at-risk individuals
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Bitzan, Lisa Valerie [Verfasser]. "Subtle Structural White Matter Changes Correlate with Positive Symptoms in Individuals at High Risk for Psychosis / Lisa Valerie Bitzan". Hamburg : Staats- und Universitätsbibliothek Hamburg Carl von Ossietzky, 2020. http://d-nb.info/1234150301/34.
Texto completo da fonteLivros sobre o assunto "High-Risk for psychosis"
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Addington, Jean, Shona M. Francey e Anthony P. Morrison, eds. Working with People at High Risk of Developing Psychosis. Chichester, UK: John Wiley & Sons, Ltd, 2005. http://dx.doi.org/10.1002/9780470712979.
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Jean, Addington, Francey Shona M e Morrison Anthony P. 1969-, eds. Working with people at high risk of developing psychosis: A treatment handbook. Chichester, England: Wiley, 2006.
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French, Paul, e Anthony P. Morrison, eds. Early Detection and Cognitive Therapy for People at High Risk of Developing Psychosis. West Sussex, London: John Wiley & Sons, Ltd, 2004. http://dx.doi.org/10.1002/9780470713259.
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Morrison, Anthony P., Jean Addington e Shona Francey. Working with People at High Risk of Developing Psychosis. Wiley & Sons, Incorporated, John, 2006.
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Working with People at High Risk of Developing Psychosis. New York: John Wiley & Sons, Ltd., 2006.
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Morrison, Anthony P., Jean Addington e Shona Francey. Working with People at High Risk of Developing Psychosis: A Treatment Handbook. Wiley & Sons, Incorporated, John, 2010.
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Morrison, Anthony P., Shona Francey e J. Addington. Working with People at High Risk of Developing Psychosis: A Treatment Handbook. Wiley & Sons, Limited, John, 2006.
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(Editor), Jean Addington, Shona Francey (Editor) e Anthony P. Morrison (Editor), eds. Working with People at High Risk of Developing Psychosis: A Treatment Handbook. Wiley, 2006.
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(Editor), Jean Addington, Shona Francey (Editor) e Anthony P. Morrison (Editor), eds. Working with People at High Risk of Developing Psychosis: A Treatment Handbook. Wiley, 2007.
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French, Paul, e Anthony P. Morrison. Early Detection and Cognitive Therapy for People at High Risk of Developing Psychosis. Wiley & Sons, Incorporated, John, 2004.
Encontre o texto completo da fonteCapítulos de livros sobre o assunto "High-Risk for psychosis"
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Riccardi, Cecilia, Cristiana Montemagni, Silvio Bellino, Paola Bozzatello e Paola Rocca. "Trajectories Toward Bipolar Disorder or Schizophrenia in FEP and High-Risk Mental State". In Psychosis and Personality Disorders, 1–17. Cham: Springer International Publishing, 2022. http://dx.doi.org/10.1007/978-3-031-09058-5_1.
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Smethurst, Nicola, Paul French e Anthony P. Morrison. "CBT for Individuals at High Risk of Developing Psychosis". In CBT for Schizophrenia, 57–85. Oxford: John Wiley & Sons, Ltd, 2012. http://dx.doi.org/10.1002/9781118330029.ch4.
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Schmidt, André, e Stefan Borgwardt. "Disturbed Brain Networks in the Psychosis High-Risk State?" In Brain Network Dysfunction in Neuropsychiatric Illness, 217–38. Cham: Springer International Publishing, 2021. http://dx.doi.org/10.1007/978-3-030-59797-9_11.
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French, Paul. "Early Detection and Treatment Opportunities for People at High Risk of Developing Psychosis". In Promoting Recovery in Early Psychosis, 93–98. Oxford, UK: Wiley-Blackwell, 2011. http://dx.doi.org/10.1002/9781444318814.ch11.
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Edell, William S. "The Psychometric Measurement of Schizotypy Using the Wisconsin Scales of Psychosis Proneness". In The Behavioral High-Risk Paradigm in Psychopathology, 3–46. New York, NY: Springer New York, 1995. http://dx.doi.org/10.1007/978-1-4612-4234-5_1.
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Carney, Rebekah, e 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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Fernandes, Leyan O. L., e Gregory A. Miller. "Compromised Performance and Abnormal Psychophysiology Associated With the Wisconsin Scales of Psychosis Proneness". In The Behavioral High-Risk Paradigm in Psychopathology, 47–87. New York, NY: Springer New York, 1995. http://dx.doi.org/10.1007/978-1-4612-4234-5_2.
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Hamilton, Holly K., e Daniel H. Mathalon. "Neurophysiological Models in Individuals at Clinical High Risk for Psychosis: Using Translational EEG Paradigms to Forecast Psychosis Risk and Resilience". In Advances in Neurobiology, 385–410. Cham: Springer Nature Switzerland, 2024. http://dx.doi.org/10.1007/978-3-031-69491-2_14.
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Girgis, Ragy R., Gary Brucato e Jeffrey A. Lieberman. "Persecutory Delusions and the Transition from Clinical High-Risk to Syndromal Psychosis". In Understanding and Caring for People with Schizophrenia, 14–22. New York, NY: Routledge, 2021. |: Routledge, 2020. http://dx.doi.org/10.4324/9780367854652-4.
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Schultze-Lutter, Frauke, Nina Schnyder, Chantal Michel e Stefanie J. Schmidt. "Clinical High Risk for Psychosis Syndromes Among Swiss and German Youth and Young Adults: Early Identification and Intervention". In Handbook of Attenuated Psychosis Syndrome Across Cultures, 115–42. Cham: Springer International Publishing, 2019. http://dx.doi.org/10.1007/978-3-030-17336-4_6.
Texto completo da fonteTrabalhos de conferências sobre o assunto "High-Risk for psychosis"
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Liu, Zhe, Weidi Wang, Mingxia Zhai, An Gu, Shunying Yu e Guan Ning Lin. "Predicting Psychosis Progression in Clinical High-Risk Individuals Using Peripheral Transcriptomic and Epigenomic Profiles: A Machine Learning Approach". In 2024 IEEE International Conference on Bioinformatics and Biomedicine (BIBM), 201–4. IEEE, 2024. https://doi.org/10.1109/bibm62325.2024.10822321.
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"METHADONE WITHDRAWAL PSYCHOSIS: A CLINICAL CASE". In 23° Congreso de la Sociedad Española de Patología Dual (SEPD) 2021. SEPD, 2021. http://dx.doi.org/10.17579/sepd2021p132v.
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The purpose of this article is, through a clinical case, to review the literature on psychosis secondary to methadone withdrawal. Observation of the patient and consultation of the clinical file. Non-systematic literature review on methadone use, methadone discontinuation and dual pathology. A 47-year-old male, history of opioid and cannabinoid use disorder, currently in abstinence and under opioid substitution therapy with methadone. After abrupt discontinuation of methadone, he began presenting delusional ideas of jealousy and persecution with multiple delusional interpretations. A diagnosis of persistent delusional disorder was made, and he was medicated with long-term injectable aripiprazole. Methadone is a synthetic opioid agonist used to treat addictions to opioids, such as heroin. Methadone maintenance treatment (MMT) contributes to cessation or reduction of heroin use, reduced risk of HIV and hepatitis virus infections, decreased mortality, improved family and social relationships and employment status. Side effects include dizziness, drowsiness, vomiting, sweating, respiratory depression and prolongation of the QT interval. Other important consequences are precipitation of withdrawal symptoms with consequent relapse to heroin use and withdrawal from MMT. Methadone withdrawal leads to the classic symptoms of opiate withdrawal - abnormalities in vital signs, dilated pupils, agitation, irritability, insomnia, sneezing, nausea and vomiting. In a minority of cases, it can lead to the sudden onset of affective disorders and psychotic disorders. Although scarce, psychotic symptoms after opioid withdrawal have already been described in the literature. Opioids function not only as neurotransmitters, but also as neuromodulators that may be involved in the regulation of the dopaminergic system. An altered neuromodulation of the central opioid-dopamine systems due to long-term MTM may be related to psychotic pathogenesis. Considering the high prevalence of psychiatric comorbidity in patients with substance use disorder, it's important to pay attention and monitor any change in opioid medication, with close observation for possible psychotic symptoms.
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McDonnell, Jolie, William Hord, Jenna Reinen, Pablo Polosecki, Irina Rish e Guillermo Cecchi. "Predicting conversion to psychosis in clinical high risk patients using resting-state functional MRI features". In Biomedical Applications in Molecular, Structural, and Functional Imaging, editado por Barjor Gimi e Andrzej Krol. SPIE, 2019. http://dx.doi.org/10.1117/12.2525341.
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Agurto, Carla, Mary Pietrowicz, Raquel Norel, Elif K. Eyigoz, Emma Stanislawski, Guillermo Cecchi e Cheryl Corcoran. "Analyzing acoustic and prosodic fluctuations in free speech to predict psychosis onset in high-risk youths". In 2020 42nd Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC) in conjunction with the 43rd Annual Conference of the Canadian Medical and Biological Engineering Society. IEEE, 2020. http://dx.doi.org/10.1109/embc44109.2020.9176841.
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Zozulya, Svetlana, Maria Omelchenko, Irina Otman, Zoya Sarmanova, Valentina Migalina, Vasily Kaleda e Tatyana Klyushnik. "LEVELS OF PRO- AND ANTI-INFLAMMATORY CYTOKINES AND THEIR RATIO IN PATIENTS WITH CLINICALLY HIGH RISK OF PSYCHOSIS". In XX INTERNATIONAL INTERDISCIPLINARY CONGRESS NEUROSCIENCE FOR MEDICINE AND PSYCHOLOGY, 121–22. LCC MAKS Press, 2024. http://dx.doi.org/10.29003/m3896.sudak.ns2024-20/121-122.
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Lima, Thayane Araújo, e Cláudio Brandão dos Santos Filho. "Neuropsychiatric sequelae of COVID - 19 and factors related to its neurotropic mechanism: an integrative review". In XIII Congresso Paulista de Neurologia. Zeppelini Editorial e Comunicação, 2021. http://dx.doi.org/10.5327/1516-3180.676.
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Background: Due to the lack of clarification on the pathophysiological mechanism of COVID - 19 in the neurological system, psychological consequences of SARS - CoV-2 infection are questioned. Objective: To describe the neuropsychiatric sequelae of COVID-19, concomitant with flu syndrome or after, and factors related to its neurotropic mechanism. Design and setting: Integrative review based on the Pubmed database. Methods: A reading of titles and abstracts was done by 2 reviewers of 260 articles, in a blind and independent way, followed by a complete reading, resulting in choice of 16 articles. Using following exclusion criteria: complete articles, publication time 2020-2021 and in English language. Results: From articles read, the following are manifested: acute psychotic episode (68.7%), anxiety (56.2%), disorders related to schizophrenia (43.7%), insomnia (43.7%) and depression (37.5%). The mechanism is multifactorial and may include direct factors of infection, corticosteroid therapy, length of stay in the ICU, female gender and stress due to social isolation. There’re reports of association of psychotic symptoms with previous coronaviruses such as SARSCoV and MERS - CoV contributing to neurotrophic hypothesis. Health professionals have an increased risk of developing psychiatric outcomes and also a high probability of having transient psychosis related to environmental stress, including the socio-environmental element to the risk factors. Conclusion: Despite few analytical studies on the topic, there’s a strong relationship between COVID-19 and neuropsychiatric manifestations, of multifactorial cause, but mainly due to the period of social confinement. Long-term follow-up of patients may provide further evidence of correlation and causality.
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Aguiar, Ana Paula, Renato Stucki, Graccielle Azevedo e 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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Korehova, M. V., I. A. Novikova, A. G. Soloviev e M. Yu Kirov. "Characteristic of the mental states of anesthesiologists and intensive care physicians under extreme conditions of activity". In INTERNATIONAL SCIENTIFIC AND PRACTICAL ONLINE CONFERENCE. Знание-М, 2020. http://dx.doi.org/10.38006/907345-50-8.2020.863.876.
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Anesthesiologists and intensive care physicians, performing their professional duties in tense and often extreme conditions of work (with risks to life and health), can be assigned to the risk group for various negative mental states. The professional activities of an anesthesiologists impose significant requirements on their personality. In order to identify and describe the characteristics the mental states of anesthesiologists and intensive care specialists, 49 physicians of the Arkhangelsk region were examined (average age 34.6 ± 13.6 years). The study used questionnaires, psychological testing (McLin’s scale of organizational stress, methodology for determining the dominant state by L. V. Kulikov, multi-level personality questionnaire «Adaptability» (MLO-AM) by A. G. Maklakov and S. V. Chermyanin, the questionnaire «Attitude to work and professional burnout» by V. A. Vinokur, the Lusher color test, the questionnaire by Ch.D. Spilberger — Yu.A. Khaninand) and statistical processing of empirical results. It has been established that in the course of fulfilling their professional duties, more than 79.6 % of anesthesiologists and intensive care physician often encounter stressful situations; every third specialist is at risk of life or danger of injury, injury during work. More than half of the respondents have a high level of organizational stress, 67.3 % have a burnout syndrome, 35.3 % are characterized by fatigue, lack of mood, lethargy, inertia, low working capacity, and 1/3 have a high rate of situational anxiety. 1/2 of anesthesiologists and intensive care physicians have reduced level of adaptive abilities, asthenic are expressed in 14.2 %, and psychotic reactions and conditions — in 24.4 %. The article offers recommendations for the prevention of negative mental states of anesthesiologists and intensive care physicians.
Relatórios de organizações sobre o assunto "High-Risk for psychosis"
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McDonagh, Marian S., Jesse Wagner, Azrah Y. Ahmed, Benjamin Morasco, Devan Kansagara e Roger Chou. Living Systematic Review on Cannabis and Other Plant-Based Treatments for Chronic Pain: May 2021 Update. Agency for Healthcare Research and Quality (AHRQ), junho de 2021. http://dx.doi.org/10.23970/ahrqepccerplantpain3.
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Overview This is the third quarterly progress report for an ongoing living systematic review on cannabis and other plant-based treatments for chronic pain. The first progress report was published in January 2021 and the second in March 2021. The draft systematic review was available for public comment from May 19 through June 15, 2021, on the Agency for Healthcare Research and Quality (AHRQ) Effective Health Care website. The systematic review synthesizes evidence on the benefits and harms of plant-based compounds (PBCs), such as cannabinoids and kratom, used to treat chronic pain, addressing concerns about severe adverse effects, abuse, misuse, dependence, and addiction. The purpose of this progress report is to describe the cumulative literature identified thus far. This report will be periodically updated with new studies as they are published and identified, culminating in an annual systematic review that provides a synthesis of the accumulated evidence. Main Points In patients with chronic (mainly neuropathic) pain with short-term treatment (4 weeks to <6 months): • Studies of cannabis-related products were grouped based on their tetrahydrocannabinol (THC) to cannabidiol (CBD) ratio using the following categories: high THC to CBD, comparable THC to CBD, and low THC to CBD. • Comparable THC to CBD ratio oral spray is probably associated with small improvements in pain severity and may be associated with small improvements in function. There was no effect in pain interference or serious adverse events. There may be a large increased risk of dizziness and sedation, and a moderate increased risk of nausea. • Synthetic THC (high THC to CBD) may be associated with moderate improvement in pain severity and increased risk of sedation, and large increased risk of nausea. Synthetic THC is probably associated with a large increased risk of dizziness. • Extracted whole-plant high THC to CBD ratio products may be associated with large increases in risk of withdrawal due to adverse events and dizziness. • Evidence on whole-plant cannabis, low THC to CBD ratio products (topical CBD), other cannabinoids (cannabidivarin), and comparisons with other active interventions was insufficient to draw conclusions. • Other key adverse event outcomes (psychosis, cannabis use disorder, cognitive deficits) and outcomes on the impact on opioid use were not reported. • No evidence on other plant-based compounds, such as kratom, met criteria for this review.
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Chou, Roger, Azrah Y. Ahmed, Benjamin J. Morasco, Christina Bougatsos, Tracy Dana, Rongwei Fu e Terran Gilbreath. Living Systematic Review on Cannabis and Other Plant-Based Treatments for Chronic Pain: 2023 Update. Agency for Healthcare Research and Quality, agosto de 2023. http://dx.doi.org/10.23970/ahrqepccer250update2023.
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Objectives. To update the evidence on benefits and harms of cannabinoids and other plant-based compounds to treat sub-acute and chronic pain in adults and adolescents using a living systematic review approach. Data sources. Ovid® MEDLINE®, PsycINFO®, Embase®, the Cochrane Library, and SCOPUS® databases; and reference lists of included studies were searched to April 23, 2023. Review methods. An updated protocol with expanded inclusion criteria (addition of sub-acute [4 to 12 weeks’ duration] pain and adolescents) was posted on the PROSPERO registry. We grouped studies based on their THC to CBD ratio and by product type, i.e. whole-plant (extracted or purified), or synthetic. We conducted random effects meta-analyses and categorized magnitude of benefit (large, moderate, small, or no effect [less than small]). Results. Two new RCTs (n=115 and 15) and two new observational studies (N=2,071) were added for this annual update; no study addressed subacute pain or adolescents. One new RCT compared high and low THC to CBD ratio products versus placebo; the other new RCT evaluated was very small and had methodological limitations. Since the inception of this living review, from 5,228 total abstracts identified, 23 RCTs (N=2,035) and 10 observational studies (N=15,840) assessing different cannabinoids were included; no study evaluated kratom. Studies were primarily short term, and 58 percent enrolled patients with neuropathic pain. Comparators were primarily placebo or usual care. Strength of evidence was low, unless indicated otherwise. Compared with placebo, plant-extracted, comparable ratio THC to CBD oral spray was associated with a small decrease in pain severity (7 RCTs, N=632, 0 to 10 scale, mean difference [MD] −0.54, 95% confidence interval [CI] −0.95 to −0.19, I2=39%; SOE: moderate) and overall function (6 RCTs, N=616, 0 to 10 scale, MD −0.42, 95% CI −0.73 to −0.16, I2=32%; SOE: moderate) versus placebo. There was no effect on study withdrawals due to adverse events. There was a large increased risk of dizziness and sedation, and a moderate increased risk of nausea (dizziness: 6 RCTs, N=866, 31.0% vs. 8.0%, relative risk [RR] 3.57, 95% CI 2.42 to 5.60, I2=0%; sedation: 6 RCTs, N=866, 8.0% vs. 1.2%, RR 5.04, 95% CI 2.10 to 11.89, I2=0%; and nausea: 6 RCTs, N=866, 13% vs. 7.5%, RR 1.79, 95% CI 1.19 to 2.77, I2=0%). Synthetic high-THC to CBD ratio products were associated with a small improvement in pain severity, a moderate increase in sedation, and a large increase in risk of nausea following the addition of one new RCT (pain: 7 RCTs, N=448, 0 to 10 scale, MD −0.95, 95% CI −1.81 to −0.25, I2=60%; sedation: 4 RCTs, N=386, 19% vs. 12%, RR 1.60, 95% CI 1.01 to 2.95, I2=8%; nausea: 3 RCTs, N=353, 11.1% vs. 5.2%, RR 2.22, 95% CI 0.90 to 5.05; I²=0%). There was also moderate SOE for a large increased risk of dizziness (3 RCTs, N=353, 29% vs. 11%, RR 2.52, 95% CI 1.20 to 4.82, I2=41%). Extracted whole-plant high-THC to CBD ratio products (oral) were associated with a large increased risk of study withdrawal due to adverse events (1 RCT, viii 13.9% vs. 5.7%, RR 3.12, 95% CI 1.54 to 6.33) and dizziness (1 RCT, 62.2% vs. 7.5%, RR 8.34, 95% CI 4.53 to 15.34); outcomes assessing benefit were not reported or insufficient. Evidence (including observational studies) on whole-plant cannabis, topical or oral CBD, low-THC to CBD products (2 new RCTs), other cannabinoids, comparisons with active non-cannabis treatments or between cannabis-related products, and impact on use of opioids also remained insufficient. Evidence was not available on important harms such as psychosis, cannabis use disorder, and cognitive effects. Conclusions. Low to moderate strength evidence suggests small improvements in pain (mostly neuropathic), and moderate to large increases in common adverse events (dizziness, sedation, nausea) with high and comparable THC to CBD ratio extracted cannabinoids and synthetic products versus placebo during short-term treatment (1 to 6 months) in adults with chronic pain. Evidence for low-THC to CBD ratio products, whole-plant cannabis, and other comparisons, outcomes, and plant-based compounds was unavailable or insufficient to draw conclusions.
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Chou, Roger, Jesse Wagner, Azrah Y. Ahmed, Benjamin J. Morasco, Devan Kansagara, Shelley Selph, Rebecca Holmes e Rongwei Fu. Living Systematic Review on Cannabis and Other Plant-Based Treatments for iii Chronic Pain: 2022 Update. Agency for Healthcare Research and Quality (AHRQ), setembro de 2022. http://dx.doi.org/10.23970/ahrqepccer250update2022.
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Objectives. To update the evidence on benefits and harms of cannabinoids and similar plant-based compounds to treat chronic pain using a living systematic review approach. Data sources. Ovid® MEDLINE®, PsycINFO®, Embase®, the Cochrane Library, and SCOPUS® databases; reference lists of included studies; and submissions received after Federal Register request were searched to April 4, 2022. Review methods. Using dual review, we screened search results for randomized controlled trials (RCTs) and observational studies of patients with chronic pain evaluating cannabis, kratom, and similar compounds with any comparison group and at least 1 month of treatment or followup. Dual review was used to abstract study data, assess study-level risk of bias, and rate the strength of evidence (SOE). Prioritized outcomes included pain, overall function, and adverse events. We grouped studies that assessed tetrahydrocannabinol (THC) and/or cannabidiol (CBD) based on their THC to CBD ratio and categorized them as comparable THC to CBD ratio, high-THC to CBD ratio, and low-THC to CBD ratio. We also grouped studies by whether the product was a whole-plant product (cannabis), cannabinoids extracted or purified from a whole plant, or a synthetic product. We conducted meta-analyses using the profile likelihood random effects model and assessed between-study heterogeneity using Cochran’s Q statistic chi square test and the I2 statistic. Magnitude of benefit was categorized as no effect or small, moderate, and large effects. Results. From 3,283 abstracts, 21 RCTs (N=1,905) and 8 observational studies (N=13,769) assessing different cannabinoids were included; none evaluated kratom. Studies were primarily short term, and 59 percent enrolled patients with neuropathic pain. Comparators were primarily placebo or usual care. The SOE was low unless otherwise noted. Compared with placebo, comparable THC to CBD ratio oral spray was associated with a small benefit in change in pain severity (7 RCTs, N=632, 0 to10 scale, mean difference [MD] −0.54, 95% confidence interval [CI] −0.95 to −0.19, I2=39%; SOE: moderate) and overall function (6 RCTs, N=616, 0 to 10 scale, MD −0.42, 95% CI −0.73 to −0.16, I2=32%). There was no effect on study withdrawals due to adverse events. There was a large increased risk of dizziness and sedation, and a moderate increased risk of nausea (dizziness: 6 RCTs, N=866, 31.0% vs. 8.0%, relative risk [RR] 3.57, 95% CI 2.42 to 5.60, I2=0%; sedation: 6 RCTs, N=866, 8.0% vs. 1.2%, RR 5.04, 95% CI 2.10 to 11.89, I2=0%; and nausea: 6 RCTs, N=866, 13% vs. 7.5%, RR 1.79, 95% CI 1.19 to 2.77, I2=0%). Synthetic products with high-THC to CBD ratios were associated with a moderate improvement in pain severity, a moderate increase in sedation, and a large increase in nausea (pain: 6 RCTs, N=390, 0 to 10 scale, MD −1.15, 95% CI −1.99 to −0.54, I2=48%; sedation: 3 RCTs, N=335, 19% vs. 10%, RR 1.73, 95% CI 1.03 to 4.63, I2=28%; nausea: 2 RCTs, N=302, 12.3% vs. 6.1%, RR 2.19, 95% CI 0.77 to 5.39; I²=0%). We also found moderate SOE for a large increased risk of dizziness (2 RCTs, 32% vs. 11%, RR 2.74, 95% CI 1.47 to 6.86, I2=40%). Extracted whole-plant products with high-THC to CBD ratios (oral) were associated with a large increased risk of study withdrawal due to adverse events (1 RCT, 13.9% vs. 5.7%, RR 3.12, 95% CI 1.54 to 6.33) and dizziness (1 RCT, 62.2% vs. 7.5%, RR 8.34, 95% CI 4.53 to 15.34); outcomes assessing benefit were not reported or insufficient. We observed a moderate improvement in pain severity when combining all studies of high-THC to CBD ratio (8 RCTs, N=684, MD −1.25, 95% CI −2.09 to −0.71, I2=58%; SOE: moderate). Evidence (including observational studies) on whole-plant cannabis, topical or oral CBD, low-THC to CBD, other cannabinoids, comparisons with active products or between cannabis-related products, and impact on use of opioids was insufficient to draw conclusions. Other important harms (psychosis, cannabis use disorder, and cognitive effects) were not reported. Conclusions. Low to moderate strength evidence suggests small to moderate improvements in pain (mostly neuropathic), and moderate to large increases in common adverse events (dizziness, sedation, nausea) with high- and comparable THC to CBD ratio extracted cannabinoids and synthetic products during short-term treatment (1 to 6 months); high-THC to CBD ratio products were also associated with increased risk of withdrawal due to adverse events. Evidence for whole-plant cannabis and other comparisons, outcomes, and plant-based compounds was unavailable or insufficient to draw conclusions. Small sample sizes, lack of evidence for moderate and long-term use and other key outcomes, such as other adverse events and impact on use of opioids during treatment, indicate that more research is needed.
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Chou, Roger, Azrah Y. Ahmed, Christina Bougatsos, Benjamin J. Morasco, Rebecca Holmes, Terran Gilbreath e Rongwei Fu. Living Systematic Review on Cannabis and Other Plant-Based Treatments for Chronic Pain: 2022 Update—Surveillance Report 2. Agency for Healthcare Research and Quality (AHRQ), janeiro de 2023. http://dx.doi.org/10.23970/ahrqepccer250.2022updatesr2.
Texto completo da fonteResumo:
Objectives. To update the evidence on benefits and harms of cannabinoids and similar plant-based compounds to treat chronic pain using a living systematic review approach. Data sources. Ovid® MEDLINE®, PsycINFO®, Embase®, the Cochrane Library, and SCOPUS® databases; reference lists of included studies; and submissions received after Federal Register request were searched to October 24, 2022. Review methods. Using dual review, we screened search results for randomized controlled trials (RCTs) and observational studies of patients with chronic pain evaluating cannabis, kratom, and similar compounds with any comparison group and at least 1 month of treatment or followup. Dual review was used to abstract study data, assess study-level risk of bias, and rate the strength of evidence (SOE). Prioritized outcomes included pain, overall function, and adverse events. We grouped studies that assessed tetrahydrocannabinol (THC) and/or cannabidiol (CBD) based on their THC to CBD ratio and categorized them as comparable THC to CBD ratio, high-THC to CBD ratio, and low-THC to CBD ratio. We also grouped studies by whether the product was a whole-plant product (cannabis), cannabinoids extracted or purified from a whole plant, or a synthetic product. We conducted meta-analyses using the profile likelihood random effects model and assessed between-study heterogeneity using Cochran’s Q statistic chi square test and the I2 statistic. Magnitude of benefit was categorized as no effect or small, moderate, and large effects. Results. From a total of 3,568 abstracts, 21 RCTs (N=1,905) and 9 observational studies (N=15,079) assessing different cannabinoids were included; none evaluated kratom. Studies were primarily short term, and 60 percent enrolled patients with neuropathic pain. Comparators were primarily placebo or usual care. The SOE was low unless otherwise noted. Compared with placebo, comparable THC to CBD ratio oral spray was associated with a small benefit in pain severity (7 RCTs, N=632, 0 to 10 scale, mean difference [MD] −0.54, 95% confidence interval [CI] −0.95 to −0.19, I2=39%; SOE: moderate) and overall function (6 RCTs, N=616, 0 to 10 scale, MD −0.42, 95% CI −0.73 to −0.16, I2=32%). There was no effect on study withdrawals due to adverse events. There was a large increased risk of dizziness and sedation, and a moderate increased risk of nausea (dizziness: 6 RCTs, N=866, 31.0% vs. 8.0%, relative risk [RR] 3.57, 95% CI 2.42 to 5.60, I2=0%; sedation: 6 RCTs, N=866, 8.0% vs. 1.2%, RR 5.04, 95% CI 2.10 to 11.89, I2=0%; and nausea: 6 RCTs, N=866, 13% vs. 7.5%, RR 1.79, 95% CI 1.19 to 2.77, I2=0%). Synthetic products with high-THC to CBD ratios were associated with a moderate improvement in pain severity, a moderate increase in sedation, and a large increase in nausea (pain: 6 RCTs, N=390, 0 to 10 scale, MD −1.15, 95% CI −1.99 to −0.54, I2=48%; sedation: 3 RCTs, N=335, 19% vs. 10%, RR 1.73, 95% CI 1.03 to 4.63, I2=28%; nausea: 2 RCTs, N=302, 12.3% vs. 6.1%, RR 2.19, 95% CI 0.77 to 5.39; I²=0%). We also found moderate SOE for a large increased risk of dizziness (2 RCTs, 32% vs. 11%, RR 2.74, 95% CI 1.47 to 6.86, I2=40%). Extracted whole-plant products with high-THC to CBD ratios (oral) were associated with a large increased risk of study withdrawal due to adverse events (1 RCT, 13.9% vs. 5.7%, RR 3.12, 95% CI 1.54 to 6.33) and dizziness (1 RCT, 62.2% vs. 7.5%, RR 8.34, 95% CI 4.53 to 15.34); outcomes assessing benefit were not reported or insufficient. We observed a moderate improvement in pain severity when combining all studies of high-THC to CBD ratio (8 RCTs, N=684, MD −1.25, 95% CI −2.09 to −0.71, I2=58%; SOE: moderate). Evidence (including observational studies) on whole-plant cannabis, topical or oral CBD, low-THC to CBD, other cannabinoids, comparisons with active products or between cannabis-related products, and impact on use of opioids was insufficient to draw conclusions. Other important harms (psychosis, cannabis use disorder, and cognitive effects) were not reported. Conclusions. Low to moderate strength evidence suggests small to moderate improvements in pain (mostly neuropathic), and moderate to large increases in common adverse events (dizziness, sedation, nausea) with high and comparable THC to CBD ratio extracted cannabinoids and synthetic products during short-term treatment (1 to 6 months); high-THC to CBD ratio products were also associated with increased risk of withdrawal due to adverse events. Evidence for whole-plant cannabis and other comparisons, outcomes, and plant-based compounds was unavailable or insufficient to draw conclusions. Small sample sizes, lack of evidence for moderate and long-term use and other key outcomes, such as other adverse events and impact on use of opioids during treatment, indicate that more research is needed.
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McDonagh, Marian S., Jesse Wagner, Azrah Y. Ahmed, Rongwei Fu, Benjamin Morasco, Devan Kansagara e Roger Chou. Living Systematic Review on Cannabis and Other Plant-Based Treatments for Chronic Pain. Agency for Healthcare Research and Quality (AHRQ), outubro de 2021. http://dx.doi.org/10.23970/ahrqepccer250.
Texto completo da fonteResumo:
Objectives. To evaluate the evidence on benefits and harms of cannabinoids and similar plant-based compounds to treat chronic pain. Data sources. Ovid® MEDLINE®, PsycINFO®, Embase®, the Cochrane Library, and SCOPUS® databases, reference lists of included studies, submissions received after Federal Register request were searched to July 2021. Review methods. Using dual review, we screened search results for randomized controlled trials (RCTs) and observational studies of patients with chronic pain evaluating cannabis, kratom, and similar compounds with any comparison group and at least 1 month of treatment or followup. Dual review was used to abstract study data, assess study-level risk of bias, and rate the strength of evidence. Prioritized outcomes included pain, overall function, and adverse events. We grouped studies that assessed tetrahydrocannabinol (THC) and/or cannabidiol (CBD) based on their THC to CBD ratio and categorized them as high-THC to CBD ratio, comparable THC to CBD ratio, and low-THC to CBD ratio. We also grouped studies by whether the product was a whole-plant product (cannabis), cannabinoids extracted or purified from a whole plant, or synthetic. We conducted meta-analyses using the profile likelihood random effects model and assessed between-study heterogeneity using Cochran’s Q statistic chi square and the I2 test for inconsistency. Magnitude of benefit was categorized into no effect or small, moderate, and large effects. Results. From 2,850 abstracts, 20 RCTs (N=1,776) and 7 observational studies (N=13,095) assessing different cannabinoids were included; none of kratom. Studies were primarily short term, and 75 percent enrolled patients with a variety of neuropathic pain. Comparators were primarily placebo or usual care. The strength of evidence (SOE) was low, unless otherwise noted. Compared with placebo, comparable THC to CBD ratio oral spray was associated with a small benefit in change in pain severity (7 RCTs, N=632, 0 to10 scale, mean difference [MD] −0.54, 95% confidence interval [CI] −0.95 to −0.19, I2=28%; SOE: moderate) and overall function (6 RCTs, N=616, 0 to 10 scale, MD −0.42, 95% CI −0.73 to −0.16, I2=24%). There was no effect on study withdrawals due to adverse events. There was a large increased risk of dizziness and sedation and a moderate increased risk of nausea (dizziness: 6 RCTs, N=866, 30% vs. 8%, relative risk [RR] 3.57, 95% CI 2.42 to 5.60, I2=0%; sedation: 6 RCTs, N=866, 22% vs. 16%, RR 5.04, 95% CI 2.10 to 11.89, I2=0%; and nausea: 6 RCTs, N=866, 13% vs. 7.5%, RR 1.79, 95% CI 1.20 to 2.78, I2=0%). Synthetic products with high-THC to CBD ratios were associated with a moderate improvement in pain severity, a moderate increase in sedation, and a large increase in nausea (pain: 6 RCTs, N=390 to 10 scale, MD −1.15, 95% CI −1.99 to −0.54, I2=39%; sedation: 3 RCTs, N=335, 19% vs. 10%, RR 1.73, 95% CI 1.03 to 4.63, I2=0%; nausea: 2 RCTs, N=302, 12% vs. 6%, RR 2.19, 95% CI 0.77 to 5.39; I²=0%). We found moderate SOE for a large increased risk of dizziness (2 RCTs, 32% vs. 11%, RR 2.74, 95% CI 1.47 to 6.86, I2=0%). Extracted whole-plant products with high-THC to CBD ratios (oral) were associated with a large increased risk of study withdrawal due to adverse events (1 RCT, 13.9% vs. 5.7%, RR 3.12, 95% CI 1.54 to 6.33) and dizziness (1 RCT, 62.2% vs. 7.5%, RR 8.34, 95% CI 4.53 to 15.34). We observed a moderate improvement in pain severity when combining all studies of high-THC to CBD ratio (8 RCTs, N=684, MD −1.25, 95% CI −2.09 to −0.71, I2=50%; SOE: moderate). Evidence on whole-plant cannabis, topical CBD, low-THC to CBD, other cannabinoids, comparisons with active products, and impact on use of opioids was insufficient to draw conclusions. Other important harms (psychosis, cannabis use disorder, and cognitive effects) were not reported. Conclusions. Low to moderate strength evidence suggests small to moderate improvements in pain (mostly neuropathic), and moderate to large increases in common adverse events (dizziness, sedation, nausea) and study withdrawal due to adverse events with high- and comparable THC to CBD ratio extracted cannabinoids and synthetic products in short-term treatment (1 to 6 months). Evidence for whole-plant cannabis, and other comparisons, outcomes, and PBCs were unavailable or insufficient to draw conclusions. Small sample sizes, lack of evidence for moderate and long-term use and other key outcomes, such as other adverse events and impact on use of opioids during treatment, indicate that more research is needed.
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Can we prevent psychosis in high-risk adolescents? ACAMH, fevereiro de 2021. http://dx.doi.org/10.13056/acamh.14671.
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Progressive cortical thinning might identify children at risk of developing psychotic spectrum symptoms. ACAMH, março de 2021. http://dx.doi.org/10.13056/acamh.15013.
Texto completo da fonteResumo:
Offspring of patients with schizophrenia or bipolar disorder have an increased risk of developing these conditions. However, our capacity to predict the long-term outcomes of these at-risk individuals is limited. Now, researchers have investigated whether longitudinal changes in brain structure differ in individuals at high familial risk who develop psychotic spectrum symptoms, compared to those who do not and to low-risk controls.