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Yung, Alison R., Alison R. Yung, Hok Pan Yuen, Patrick D. Mcgorry, Lisa J. Phillips, Daniel Kelly, Margaret Dell'olio, et al. "Mapping the Onset of Psychosis: The Comprehensive Assessment of At-Risk Mental States." Australian & New Zealand Journal of Psychiatry 39, no. 11-12 (November 2005): 964–71. http://dx.doi.org/10.1080/j.1440-1614.2005.01714.x.
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Objective: Recognizing the prodrome of a first psychotic episode prospectively creates the opportunity of intervention, which could delay, ameliorate or even prevent onset. Valid criteria and a reliable methodology for identifying possible prodromes are needed. This paper describes an instrument, the Comprehensive Assessment of At-Risk Mental States (CAARMS), which has been designed for such a purpose. It has two functions: (i) to assess psychopathology thought to indicate imminent development of a first-episode psychotic disorder; and (ii) to determine if an individual meets criteria for being at ultra high risk (UHR) for onset of first psychotic disorder. This paper describes the pilot evaluation of the CAARMS. Method: Several methodologies were used to test the CAARMS. First, CAARMS scores in a group of UHR young people and the association between CAARMS scores and the risk of transition to psychotic disorder, were analysed. Second, CAARMS scores in a UHR group were compared to a control group. To assess concurrent validity, CAARMS-defined UHR criteria were compared to the existing criteria for identifying the UHR cohort. To assess predictive validity, the CAARMS-defined UHR criteria were applied to a sample of 150 non-psychotic help-seekers and rates of onset of psychotic disorder at 6-month follow-up determined for the CAARMS-positive (i.e. met UHR criteria) group and the CAARMS-negative (i.e. did not meet UHR criteria) group. The inter-rater reliability of the CAARMS was assessed by using pairs of raters. Results: High CAARMS score in the UHR group was significantly associated with onset of psychotic disorder. The control group had significantly lower CAARMS scores than the UHR group. The UHR criteria assessed by the CAARMS identified a similar group to the criteria measured by existing methodology. In the sample of non-psychotic help-seekers those who were CAARMS-positive were at significantly increased risk of onset of psychotic disorder compared to those who were CAARMS-negative (relative risk of 12.44 (95% CI=1.5–103.41, p=0.0025)). The CAARMS had good to excellent reliability. Conclusions: In these preliminary investigations, the CAARMS displayed good to excellent concurrent, discriminant and predictive validity and excellent inter-rater reliability. The CAARMS instrument provides a useful platform for monitoring sub threshold psychotic symptoms for worsening into full-threshold psychotic disorder.
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Oliver, D., M. Kotlicka-Antczak, A. Minichino, G. Spada, P. McGuire, and P. Fusar-Poli. "Meta-analytical prognostic accuracy of the Comprehensive Assessment of at Risk Mental States (CAARMS): The need for refined prediction." European Psychiatry 49 (2018): 62–68. http://dx.doi.org/10.1016/j.eurpsy.2017.10.001.
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AbstractPrimary indicated prevention is reliant on accurate tools to predict the onset of psychosis. The gold standard assessment for detecting individuals at clinical high risk (CHR-P) for psychosis in the UK and many other countries is the Comprehensive Assessment for At Risk Mental States (CAARMS). While the prognostic accuracy of CHR-P instruments has been assessed in general, this is the first study to specifically analyse that of the CAARMS. As such, the CAARMS was used as the index test, with the reference index being psychosis onset within 2 years. Six independent studies were analysed using MIDAS (STATA 14), with a total of 1876 help-seeking subjects referred to high risk services (CHR-P+: n = 892; CHR-P–: n = 984). Area under the curve (AUC), summary receiver operating characteristic curves (SROC), quality assessment, likelihood ratios, and probability modified plots were computed, along with sensitivity analyses and meta-regressions. The current meta-analysis confirmed that the 2-year prognostic accuracy of the CAARMS is only acceptable (AUC = 0.79 95% CI: 0.75–0.83) and not outstanding as previously reported. In particular, specificity was poor. Sensitivity of the CAARMS is inferior compared to the SIPS, while specificity is comparably low. However, due to the difficulties in performing these types of studies, power in this meta-analysis was low. These results indicate that refining and improving the prognostic accuracy of the CAARMS should be the mainstream area of research for the next era. Avenues of prediction improvement are critically discussed and presented to better benefit patients and improve outcomes of first episode psychosis.
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Yung, A. R., H. P. Yuen, L. J. Phillips, S. Francey, and P. D. McGorry. "Mapping the onset of psychosis: The comprehensive assessment of at risk mental states (CAARMS)." Schizophrenia Research 60, no. 1 (March 2003): 30–31. http://dx.doi.org/10.1016/s0920-9964(03)80090-7.
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Nelson, B., A. R. Yung, S. M. Francey, and P. D. McGorry. "0264 ASSESSING THOSE AT HIGH RISK OF PSYCHOTIC DISORDER USING THE COMPREHENSIVE ASSESSMENT OF AT RISK MENTAL STATES (CAARMS)." Schizophrenia Research 86 (October 2006): S79. http://dx.doi.org/10.1016/s0920-9964(06)70234-1.
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Valmaggia, L. R., D. Stahl, A. R. Yung, B. Nelson, P. Fusar-Poli, P. D. McGorry, and P. K. McGuire. "Negative psychotic symptoms and impaired role functioning predict transition outcomes in the at-risk mental state: a latent class cluster analysis study." Psychological Medicine 43, no. 11 (February 27, 2013): 2311–25. http://dx.doi.org/10.1017/s0033291713000251.
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BackgroundMany research groups have attempted to predict which individuals with an at-risk mental state (ARMS) for psychosis will later develop a psychotic disorder. However, it is difficult to predict the course and outcome based on individual symptoms scores.MethodData from 318 ARMS individuals from two specialized services for ARMS subjects were analysed using latent class cluster analysis (LCCA). The score on the Comprehensive Assessment of At-Risk Mental States (CAARMS) was used to explore the number, size and symptom profiles of latent classes.ResultsLCCA produced four high-risk classes, censored after 2 years of follow-up: class 1 (mild) had the lowest transition risk (4.9%). Subjects in this group had the lowest scores on all the CAARMS items, they were younger, more likely to be students and had the highest Global Assessment of Functioning (GAF) score. Subjects in class 2 (moderate) had a transition risk of 10.9%, scored moderately on all CAARMS items and were more likely to be in employment. Those in class 3 (moderate–severe) had a transition risk of 11.4% and scored moderately severe on the CAARMS. Subjects in class 4 (severe) had the highest transition risk (41.2%), they scored highest on the CAARMS, had the lowest GAF score and were more likely to be unemployed. Overall, class 4 was best distinguished from the other classes on the alogia, avolition/apathy, anhedonia, social isolation and impaired role functioning.ConclusionsThe different classes of symptoms were associated with significant differences in the risk of transition at 2 years of follow-up. Symptomatic clustering predicts prognosis better than individual symptoms.
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Miyakoshi, Tetsuo, Kazunori Matsumoto, Fumiaki Ito, Noriyuki Ohmuro, and Hiroo Matsuoka. "Application of the Comprehensive Assessment of At-Risk Mental States (CAARMS) to the Japanese population: reliability and validity of the Japanese version of the CAARMS." Early Intervention in Psychiatry 3, no. 2 (May 2009): 123–30. http://dx.doi.org/10.1111/j.1751-7893.2009.00118.x.
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Yung, A. R., L. E. O'Dwyer, S. M. Francey, M. B. Simmons, and B. Nelson. "0553 ASSESSING THOSE AT HIGH RISK OF PSYCHOTIC DISORDER –AN EXPERIENTIAL WORKSHOP USING THE COMPREHENSIVE ASSESSMENT OF AT RISK MENTAL STATES (CAARMS)." Schizophrenia Research 86 (October 2006): S82. http://dx.doi.org/10.1016/s0920-9964(06)70244-4.
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Pelizza, Lorenzo, Federica Paterlini, Silvia Azzali, Sara Garlassi, Ilaria Scazza, Simona Pupo, Magenta Simmons, Barnaby Nelson, and Andrea Raballo. "The approved Italian version of the comprehensive assessment of at-risk mental states (CAARMS-ITA): Field test and psychometric features." Early Intervention in Psychiatry 13, no. 4 (April 26, 2018): 810–17. http://dx.doi.org/10.1111/eip.12669.
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Kim, Sung-Wan, Jae-Kyeong Kim, Ji Hun Han, Min Jhon, Ju-Wan Kim, Ju-Yeon Lee, Jae-Min Kim, et al. "Validation of the Korean Version of the 15-Item Community Assessment of Psychic Experiences in a College Population." Psychiatry Investigation 17, no. 4 (April 15, 2020): 306–11. http://dx.doi.org/10.30773/pi.2019.0215.
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Objective To investigate the reliability and validity of the Korean version of the Community Assessment of Psychic Experiences-15 item positive scale (CAPE-15) in college students.Methods This study had two stages: initial screening with self-report questionnaires including the CAPE-15, and semi-structured interviews to investigate the instrument’s diagnostic validity. The initial screening involved 1,749 college students. The modified Korean version of Prodromal Questionnaire-16 item (mKPQ-16) was also administered. The criteria for ultra-high risk (UHR) of psychosis in the Comprehensive Assessment of At-Risk Mental States (CAARMS) were the gold standard for diagnosis.Results Twelve of the interviewed subjects met the CAARMS criteria for UHR of psychosis. The area under the receiver operating characteristic curve was highest (0.936) for the CAPE-15 distress score (p<0.001). The use of 6 as the cutoff for the CAPE-15 distress score resulted in the best balance of sensitivity (91.7%) and specificity (85.2%), with a favorable positive predictive value of 32.4%. The coefficients of correlation between the CAPE-15 and mKPQ-16 were significant.Conclusion The Korean version of the CAPE-15 is a good instrument for screening for psychosis risk in collegiate settings. The validation of this scale could contribute to the early identification of psychosis in the Korean community.
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Whitney, Daniel, and Stephen Wright. "A retrospective case-control service evaluation of CAARMS scores of patients with autism in York EIP, compared to age matched controls." BJPsych Open 7, S1 (June 2021): S59—S60. http://dx.doi.org/10.1192/bjo.2021.203.
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AimsStudies show the prevalence of Autism Spectrum Conditions in Early Intervention in Psychosis (EIP) populations is 3.6-3.7%, compared to approximately 1-1.5% in the general population. The CAARMS (Comprehensive Assessment of At Risk Mental States) is a national tool used by EIP services as a screening tool to bring patients into services and stratify their symptoms to determine what pathway may be most appropriate (First Episode Psychosis pathway (FEP) or At Risk Mental State pathway (ARMS)). As far as we are aware the CAARMS has not been validated in an autistic population. It is our view that several of the questions in the CAARMS may be interpreted differently by people with autism, thus affecting the scores. The aim of this evaluation was to identify whether CAARMS scores differ between patients diagnosed with autism and matched controls in York EIP.MethodFrom their mental health records, we identified all patients in the service with a diagnosis of autism. We then compared the CAARMS scores, at the time of referral, to those of age matched controls (matched by being in the age range 16-30) without an autism diagnosis, using continuous sampling by date of referral.Result14 patients in the service had a diagnosis of autism and had completed a CAARMS. CAARMS domains are all scored between 0 and 6 (indicating increasing severity or frequency). Compared to the age matched controls, autistic patients had a higher mean difference in their scores for ‘Non-Bizarre Ideas’ (mean difference of 0.86 for severity and 0.57 for frequency) and ‘Disorganised Speech’ (mean difference of 0.28 for severity and 0.57 for frequency). These results did not reach statistical significance which was unsurprising given the sample size. The gender split between groups was similar.ConclusionOur evaluation suggests a difference in CAARMS scores between patients in our service with a diagnosis of autism and those without. A larger study would be needed to confirm a statistically significant difference and multicentre results would be needed as evidence of generalisability. However, if such a difference were confirmed it might question the validity of CAARMS in autistic patients or suggest that modifications, perhaps in the form of reasonable adjustments to the questions or scoring, were needed to increase the validity in this population. We would suggest that spending extra time checking the patient has understood the intended meaning of the questions in the CAARMS may increase validity, particularly in the ‘Non-Bizarre Ideas’ domain.
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Braham, Amel, Ahmed Souhail Bannour, Asma Ben Romdhane, Barnabay Nelson, Iheb Bougumiza, Selma Ben Nasr, Yousri ElKissi, and Bechir Ben Hadj Ali. "Validation of the Arabic version of the Comprehensive Assessment of At Risk Mental States (CAARMS) in Tunisian adolescents and young adults." Early Intervention in Psychiatry 8, no. 2 (January 24, 2013): 147–54. http://dx.doi.org/10.1111/eip.12031.
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Kim, Sung-Wan, Jung Jin Kim, Yeonghyeok Kim, Anna Jo, Jae-Kyeong Kim, Jae-Min Kim, Young Chul Chung, and Jin-Sang Yoon. "T88. VALIDATION OF THE KOREAN VERSION OF THE 15-ITEM COMMUNITY ASSESSMENT OF PSYCHIC EXPERIENCES (CAPE-15) IN A COLLEGE POPULATION." Schizophrenia Bulletin 46, Supplement_1 (April 2020): S265. http://dx.doi.org/10.1093/schbul/sbaa029.648.
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Abstract Background The Community Assessment of Psychic Experiences-Positive 15-items scale (CAPE-15) is another brief, valid screening tool used to identify people at high risk of psychosis in the community. This study examined the reliability and validity of the Korean version of the CAPE-15 in university students. Methods This study had two stages: initial screening with self-report questionnaires including the CAPE-15, and semi-structured interviews to investigate the instrument’s diagnostic validity. The initial screening involved 1,749 college students. The modified Korean version of Prodromal Questionnaire-16 item (mKPQ-16) was also administered. The criteria for ultra-high risk (UHR) of psychosis in the Comprehensive Assessment of At-Risk Mental States (CAARMS) were the gold standard for diagnosis. Results Twelve of the interviewed subjects met the CAARMS criteria for UHR of psychosis. The area under the receiver operating characteristic curve was highest (0.936) for the CAPE-15 distress score (p<0.001). The use of 6 as the cutoff for the CAPE-15 distress score resulted in the best balance of sensitivity (91.7%) and specificity (85.2%), with a favorable positive predictive value of 32.4%. The coefficients of correlation between the CAPE-15 and mKPQ-16 were significant. Discussion This study showed that the CAPE-15 is a good screening instrument for use in community and school settings. In particular, the better validity of the CAPE-15 suggests that it is a promising alternative to other brief self-report screening tools that are currently used to detect UHR. This validation of a questionnaire with a small number of items may make it feasible to screen large numbers of young adults in the community and shorten the duration of untreated psychosis through prompt early intervention.
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Modinos, Gemma, Paul Allen, Andre Zugman, Danai Dima, Matilda Azis, Carly Samson, Ilaria Bonoldi, et al. "Neural Circuitry of Novelty Salience Processing in Psychosis Risk: Association With Clinical Outcome." Schizophrenia Bulletin 46, no. 3 (September 18, 2019): 670–79. http://dx.doi.org/10.1093/schbul/sbz089.
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Abstract Psychosis has been proposed to develop from dysfunction in a hippocampal-striatal-midbrain circuit, leading to aberrant salience processing. Here, we used functional magnetic resonance imaging (fMRI) during novelty salience processing to investigate this model in people at clinical high risk (CHR) for psychosis according to their subsequent clinical outcomes. Seventy-six CHR participants as defined using the Comprehensive Assessment of At-Risk Mental States (CAARMS) and 31 healthy controls (HC) were studied while performing a novelty salience fMRI task that engaged an a priori hippocampal-striatal-midbrain circuit of interest. The CHR sample was then followed clinically for a mean of 59.7 months (~5 y), when clinical outcomes were assessed in terms of transition (CHR-T) or non-transition (CHR-NT) to psychosis (CAARMS criteria): during this period, 13 individuals (17%) developed a psychotic disorder (CHR-T) and 63 did not. Functional activation and effective connectivity within a hippocampal-striatal-midbrain circuit were compared between groups. In CHR individuals compared to HC, hippocampal response to novel stimuli was significantly attenuated (P = .041 family-wise error corrected). Dynamic Causal Modelling revealed that stimulus novelty modulated effective connectivity from the hippocampus to the striatum, and from the midbrain to the hippocampus, significantly more in CHR participants than in HC. Conversely, stimulus novelty modulated connectivity from the midbrain to the striatum significantly less in CHR participants than in HC, and less in CHR participants who subsequently developed psychosis than in CHR individuals who did not become psychotic. Our findings are consistent with preclinical evidence implicating hippocampal-striatal-midbrain circuit dysfunction in altered salience processing and the onset of psychosis.
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Zeni-Graiff, Maiara, Adiel C. Rios, Pawan K. Maurya, Lucas B. Rizzo, Sumit Sethi, Ana S. Yamagata, Rodrigo B. Mansur, et al. "Peripheral levels of superoxide dismutase and glutathione peroxidase in youths in ultra-high risk for psychosis: a pilot study." CNS Spectrums 24, no. 03 (December 17, 2017): 333–37. http://dx.doi.org/10.1017/s1092852917000803.
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IntroductionOxidative stress has been documented in chronic schizophrenia and in the first episode of psychosis, but there are very little data on oxidative stress prior to the disease onset.ObjectiveThis work aimed to compare serum levels of superoxide dismutase (SOD) and glutathione peroxidase (GPx) in young individuals at ultra-high risk (UHR) of developing psychosis with a comparison healthy control group (HC).MethodsThirteen UHR subjects and 29 age- and sex-matched healthy controls (HC) were enrolled in this study. Clinical assessment included the Comprehensive Assessment of At-Risk Mental States (CAARMS), the Semi-Structured Clinical Interview for DSM-IV Axis-I (SCID-I) or the Kiddie-SADS-Present and Lifetime Version (K-SADS-PL), and the Global Assessment of Functioning (GAF) scale. Activities of SOD and GPx were measured in serum by the spectrophotometric method using enzyme-linked immunosorbent assay kits.ResultsAfter adjusting for age and years of education, there was a significant lower activity of SOD and lower GPX activity in the UHR group compared to the healthy control group (rate ratio [RR]=0.330, 95% CI 0.187; 0.584, p<0.001 and RR=0.509, 95% CI 0.323; 0.803, p=0.004, respectively). There were also positive correlations between GAF functioning scores and GPx and SOD activities.ConclusionOur results suggest that oxidative imbalances could be present prior to the onset of full-blown psychosis, including in at-risk stages. Future studies should replicate and expand these results.
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Kroll, Jasmin, Sean Froudist-Walsh, Philip J. Brittain, Chieh-En J. Tseng, Vyacheslav Karolis, Robin M. Murray, and Chiara Nosarti. "A dimensional approach to assessing psychiatric risk in adults born very preterm." Psychological Medicine 48, no. 10 (January 19, 2018): 1738–44. http://dx.doi.org/10.1017/s0033291717003804.
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AbstractBackgroundIndividuals who were born very preterm have higher rates of psychiatric diagnoses compared with term-born controls; however, it remains unclear whether they also display increased sub-clinical psychiatric symptomatology. Hence, our objective was to utilize a dimensional approach to assess psychiatric symptomatology in adult life following very preterm birth.MethodsWe studied 152 adults who were born very preterm (before 33 weeks’ gestation; gestational range 24–32 weeks) and 96 term-born controls. Participants’ clinical profile was examined using the Comprehensive Assessment of At-Risk Mental States (CAARMS), a measure of sub-clinical symptomatology that yields seven subscales including general psychopathology, positive, negative, cognitive, behavioural, motor and emotional symptoms, in addition to a total psychopathology score. Intellectual abilities were examined using the Wechsler Abbreviated Scale of Intelligence.ResultsBetween-group differences on the CAARMS showed elevated symptomatology in very preterm participants compared with controls in positive, negative, cognitive and behavioural symptoms. Total psychopathology scores were significantly correlated with IQ in the very preterm group only. In order to examine the characteristics of participants’ clinical profile, a principal component analysis was conducted. This revealed two components, one reflecting a non-specific psychopathology dimension, and the other indicating a variance in symptomatology along a positive-to-negative symptom axis. K-means (k = 4) were used to further separate the study sample into clusters. Very preterm adults were more likely to belong to a high non-specific psychopathology cluster compared with controls.Conclusion and RelevanceVery preterm individuals demonstrated elevated psychopathology compared with full-term controls. Their psychiatric risk was characterized by a non-specific clinical profile and was associated with lower IQ.
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Modinos, Gemma, Anja Richter, Alice Egerton, Ilaria Bonoldi, Matilda Azis, Mathilde Antoniades, Matthijs Bossong, et al. "Interactions between hippocampal activity and striatal dopamine in people at clinical high risk for psychosis: relationship to adverse outcomes." Neuropsychopharmacology 46, no. 8 (May 3, 2021): 1468–74. http://dx.doi.org/10.1038/s41386-021-01019-0.
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AbstractPreclinical models propose that increased hippocampal activity drives subcortical dopaminergic dysfunction and leads to psychosis-like symptoms and behaviors. Here, we used multimodal neuroimaging to examine the relationship between hippocampal regional cerebral blood flow (rCBF) and striatal dopamine synthesis capacity in people at clinical high risk (CHR) for psychosis and investigated its association with subsequent clinical and functional outcomes. Ninety-five participants (67 CHR and 28 healthy controls) underwent arterial spin labeling MRI and 18F-DOPA PET imaging at baseline. CHR participants were followed up for a median of 15 months to determine functional outcomes with the global assessment of function (GAF) scale and clinical outcomes using the comprehensive assessment of at-risk mental states (CAARMS). CHR participants with poor functional outcomes (follow-up GAF < 65, n = 25) showed higher rCBF in the right hippocampus compared to CHRs with good functional outcomes (GAF ≥ 65, n = 25) (pfwe = 0.026). The relationship between rCBF in this right hippocampal region and striatal dopamine synthesis capacity was also significantly different between groups (pfwe = 0.035); the association was negative in CHR with poor outcomes (pfwe = 0.012), but non-significant in CHR with good outcomes. Furthermore, the correlation between right hippocampal rCBF and striatal dopamine function predicted a longitudinal increase in the severity of positive psychotic symptoms within the total CHR group (p = 0.041). There were no differences in rCBF, dopamine, or their associations in the total CHR group relative to controls. These findings indicate that altered interactions between the hippocampus and the subcortical dopamine system are implicated in the pathophysiology of adverse outcomes in the CHR state.
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Haining, Kate, Claire Matrunola, Lucy Mitchell, Ruchika Gajwani, Joachim Gross, Andrew I. Gumley, Stephen M. Lawrie, Matthias Schwannauer, Frauke Schultze-Lutter, and Peter J. Uhlhaas. "Neuropsychological deficits in participants at clinical high risk for psychosis recruited from the community: relationships to functioning and clinical symptoms." Psychological Medicine 50, no. 1 (March 13, 2019): 77–85. http://dx.doi.org/10.1017/s0033291718003975.
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AbstractBackgroundThe current study examined the pattern of neurocognitive impairments in a community-recruited sample of clinical high-risk (CHR) participants and established relationships with psychosocial functioning.MethodsCHR-participants (n = 108), participants who did not fulfil CHR-criteria (CHR-negatives) (n = 42) as well as a group of healthy controls (HCs) (n = 55) were recruited. CHR-status was assessed using the Comprehensive Assessment of At-Risk Mental States (CAARMS) and the Schizophrenia Proneness Instrument, Adult Version (SPI-A). The Brief Assessment of Cognition in Schizophrenia Battery (BACS) as well as tests for emotion recognition, working memory and attention were administered. In addition, role and social functioning as well as premorbid adjustment were assessed.ResultsCHR-participants were significantly impaired on the Symbol-Coding and Token-Motor task and showed a reduction in total BACS-scores. Moreover, CHR-participants were characterised by prolonged response times (RTs) in emotion recognition as well as by reductions in both social and role functioning, GAF and premorbid adjustments compared with HCs. Neurocognitive impairments in emotion recognition accuracy, emotion recognition RT, processing speed and motor speed were associated with several aspects of functioning explaining between 4% and 12% of the variance.ConclusionThe current data obtained from a community sample of CHR-participants highlight the importance of dysfunctions in motor and processing speed and emotion recognition RT. Moreover, these deficits were found to be related to global, social and role functioning, suggesting that neurocognitive impairments are an important aspect of sub-threshold psychotic experiences and a possible target for therapeutic interventions.
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Riva, Anna, Monica Bomba, Elisa Maserati, Francesca Neri, and Renata Nacinovich. "Impact of Bullying and Low Perceived Social Support on Ultra- High-Risk for Psychosis in Immigrant Adolescents: A Preliminary Study." International Journal of Social Science Studies 5, no. 11 (October 13, 2017): 1. http://dx.doi.org/10.11114/ijsss.v5i11.2605.
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The purpose of our research is to identify, in a sample of immigrant adolescents, the presence of Ultra-High-Risk (UHR) for psychosis and to analyze the interaction between UHR, experience of bullying victimization and low social support. Data were collected from the medical records of 31 immigrant adolescents. CAARMS (Comprehensive Assessment of At-Risk Mental States) was used to determine the presence of ultra high risk (UHR) of developing psychosis, while MSPSS (Multidimensional Scale of Perceived Social Support) for the perceived social support. 45.2% of subjects resulted at high risk for psychosis (UHR). In the UHR group the 57.1% of the subjects told to be victims of bullying (p = 0,007). The MSPSS outlined that 17.2% of the subjects declared that they received a low social support, the 58.6% average, and the 24.1% a high support. Significant differences between UHR and NOT UHR group considering a low perceived social support emerged. Considering the fixed variable “being or not being bullied”, a direct correlation between bullying (ρ = 0.431) and UHR and an indirect correlation between the MSPSS total score (ρ = -0.273) and UHR emerged. Results of the multiple linear regression considering UHR as a dependent variable confirmed that both the variables are significant (p = 0.0082) and that they both contribute to the risk of psychosis. Preliminary results of our study suggest a relevant and causal relation between bullying, low social support and psychosis in immigrant adolescents.
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Haining, Kate, Gina Brunner, Ruchika Gajwani, Joachim Gross, Andrew Gumley, Stephen Lawrie, Matthias Schwannauer, Frauke Schultze-Lutter, and Peter Uhlhaas. "S64. COGNITIVE IMPAIRMENTS AND PREDICTION OF FUNCTIONAL OUTCOME IN INDIVIDUALS AT CLINICAL HIGH-RISK FOR PSYCHOSIS." Schizophrenia Bulletin 46, Supplement_1 (April 2020): S57—S58. http://dx.doi.org/10.1093/schbul/sbaa031.130.
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Abstract Background Research in individuals at clinical-high risk for psychosis (CHR-P) has focused on developing algorithms to predict transition to psychosis. However, it is becoming increasingly important to address other outcomes, such as the level of functioning of CHR-P participants. To address this important question, this study investigated the relationship between baseline cognitive performance and functional outcome between 6–12 months in a sample of CHR-P individuals using a machine-learning approach to identify features that are predictive of long-term functional impairments. Methods Data was available for 111 CHR-P individuals at 6–12 months follow-up. In addition, 47 CHR-negative (CHR-N) participants who did not meet CHR criteria and 55 healthy controls (HCs) were recruited. CHR-P status was assessed using the Comprehensive Assessment of At-Risk Mental States (CAARMS) and the Schizophrenia Proneness Instrument, Adult version (SPI-A). Cognitive assessments included the Brief Assessment of Cognition in Schizophrenia (BACS) and the Penn Computerized Neurocognitive Battery (CNB). Global, social and role functioning scales were used to measure functional status. CHR-P individuals were divided into good functional outcome (GFO, GAF ≥ 65) and poor functional outcome groups (PFO, GAF < 65). Feature selection was performed using LASSO regression with the LARS algorithm and 10-fold cross validation with GAF scores at baseline as the outcome variable. The following features were identified as predictors of GAF scores at baseline: verbal memory, verbal fluency, attention, emotion recognition, social and role functioning and SPI-A distress. This model explained 47% of the variance in baseline GAF scores. In the next step, Support Vector Machines (SVM), Linear Discriminant Analysis (LDA), Logistic Regression (LR), Gaussian Naïve Bayes (GNB), and Random Forest (RF) classifiers with 10-fold cross validation were then trained on those features with GAF category at follow-up used as the binary label column. Models were compared using a calculated score incorporating area under the curve (AUC), accuracy, and AUC consistency across runs, whereby AUC was given a higher weighting than accuracy due to class imbalance. Results CHR-P individuals had slower motor speed, reduced attention and processing speed and increased emotion recognition reaction times (RTs) compared to HCs and reduced attention and processing speed compared to CHR-Ns. At follow-up, 66% of CHR-P individuals had PFO. LDA emerged as the strongest classifier, showing a mean AUC of 0.75 (SD = 0.15), indicating acceptable classification performance for GAF category at follow-up. PFO was detected with a sensitivity of 75% and specificity of 58%, with a total mean weighted accuracy of 68%. Discussion The CHR-P state was associated with significant impairments in cognition, highlighting the importance of interventions such as cognitive remediation in this population. Our data suggest that the development of features using machine learning approaches is effective in predicting functional outcomes in CHR-P individuals. Greater levels of accuracy, sensitivity and specificity might be achieved by increasing training sets and validating the classifier with external data sets. Indeed, machine learning methods have potential given that trained classifiers can easily be shared online, thus enabling clinical professionals to make individualised predictions.
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Nelson, Barnaby, G. Paul Amminger, Hok Pan Yuen, Melissa Kerr, Jessica Spark, Nicky Wallis, Cameron Carter, et al. "M21. THE STEP TRIAL: A SEQUENTIAL MULTIPLE ASSIGNMENT RANDOMISED TRIAL (SMART) OF INTERVENTIONS FOR PATIENTS AT ULTRA-HIGH RISK OF PSYCHOSIS - STUDY RATIONALE, DESIGN AND BASELINE DATA." Schizophrenia Bulletin 46, Supplement_1 (April 2020): S141. http://dx.doi.org/10.1093/schbul/sbaa030.333.
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Abstract Background Although approximately twenty randomised controlled trials have now been conducted with young people identified as being at high clinical risk of psychotic disorder, it remains unclear what the optimal type and sequence of treatments are for this clinical population. There has also been increased focus on clinical outcomes other than transition to psychotic disorder, such as psychosocial functioning, persistent attenuated psychotic symptoms and non-psychotic disorders. At Orygen, we are currently conducting a trial of a sequence of interventions consisting of two psychosocial therapies (support and problem solving [SPS] and cognitive-behavioural case management [CBCM]) and antidepressant medication. The primary outcome of the study is functional outcome after 6 months. This presentation will outline the background, rationale, design, recruitment and retention data and preliminary baseline results. Methods STEP is a sequential multiple assignment randomised trial (SMART) of treatments for young people (12–25 year olds) who meet ultra high risk for psychosis (UHR) criteria. Participants were recruited from primary (headspace) and secondary/tertiary (Orygen Youth Health) mental health services in Melbourne, Australia. The trial consists of three steps: Step 1: SPS (1.5 months); Step 2: SPS vs Cognitive Behavioural Case Management (4.5 months); Step 3: Cognitive Behavioural Case Management + Antidepressant Medication vs Cognitive Behavioural Case Management + Placebo (6 months). Patients who do not respond by the end of each step graduate to the next step in treatment. Responders are randomised to SPS or monitoring. Treatment response is based a combination of reduced attenuated psychotic symptoms, rated using the Comprehensive Assessment of At-Risk Mental States (CAARMS), and functional improvement (Social and Occupational Functioning Assessment Scale [SOFAS]) at the end of the treatment step. A ‘fast fail’ option is built into Step 3, whereby patients who deteriorate or have not responded 3 months into Step 3 are offered a choice of continuing existing treatment or commencing omega-3 fatty acids or low-dose antipsychotic medication. The intervention is for 12 months, with follow up at 18 and 24 months. A pilot study using the same design is currently being conducted at The University of California Davis. Results Recruitment has recently completed, with 342 patients recruited over a 2.4 year period, representing the largest UHR treatment study conducted to date. Preliminary results indicate an 8% response rate to Step 1 and a 23% response rate to Step 2. Discontinuation rates are 15% (step 1), 43% (step 2), 32% (step 3), primarily due to participants being lost to follow up or not wanting to start medication. The current transition to psychosis rate is 10.2%. Baseline clinical data are currently being analysed and will be presented at the conference. Discussion Preliminary results indicate high non-response rates following SPS and moderate non-response rates following extended SPS or CBCM, possibly partly due to the stringent definition of response, which required substantial and persistent improvement in both attenuated psychotic symptoms and functioning. Discontinuation rates are low to moderate, reflecting the complexity and severity of this clinical population. The recruitment and retention data show that it is possible to conduct large-scale and complex stepped care trials with this high risk population in a primary mental health care setting (headspace services). Outcomes will inform the most effective type and sequence of treatments for improving psychosocial functioning, symptoms and reducing risk of developing psychotic disorder in this group, as well as identify predictors of treatment response.
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Perez, Jesus, Debra A. Russo, Jan Stochl, Gillian F. Shelley, Carolyn M. Crane, Michelle Painter, James B. Kirkbride, Tim J. Croudace, and Peter B. Jones. "Understanding causes of and developing effective interventions for schizophrenia and other psychoses." Programme Grants for Applied Research 4, no. 2 (March 2016): 1–184. http://dx.doi.org/10.3310/pgfar04020.
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BackgroundEarly-intervention services (EISs) offer prompt and effective care to individuals with first-episode psychosis (FEP) and detect people at high risk (HR) of developing it.AimsWe aimed to educate general practitioners about psychosis and guide their referrals to specialist care; investigate determinants of the transition of HR to FEP; and predict numbers of new cases to guide policy and service planning.Incidence of psychosis in socially and ethnically diverse settingsWe studied the incidence of new referrals for psychosis in a well-established EIS called CAMEO [seewww.cameo.nhs.uk(accessed 18 January 2016)] and built on other epidemiological studies. The overall incidence of FEP was 45.1 per 100,000 person-years [95% confidence interval (CI) 40.8 to 49.9 per 100,000 person-years]. This was two to three times higher than the incidence predicated by the UK Department of Health. We found considerable psychosis morbidity in diverse, rural communities.Development of a population-level prediction tool for the incidence of FEPWe developed and validated a population-level prediction tool, PsyMaptic, capable of accurately estimating the expected incidence of psychosis [seewww.psymaptic.org/(accessed 18 January 2016)].The Liaison with Education and General practiceS (LEGS) trial to detect HRWe tested a theory-based intervention to improve detection and referral of HR individuals in a cluster randomised controlled trial involving primary care practices in Cambridgeshire and Peterborough. Consenting practices were randomly allocated to (1) low-intensity liaison with secondary care, a postal campaign to help with the identification and referral of individuals with early signs of psychosis, or (2) the high-intensity theory-based intervention, which, in addition to the postal campaign, included a specialist mental health professional to liaise with each practice. Practices that did not consent to be randomised included a practice-as-usual (PAU) group. The approaches were implemented over 2 years for each practice between April 2010 and October 2013. New referrals were stratified into those who met criteria for HR/FEP (together: psychosis true positives) and those who did not fulfil such criteria (false positives). The primary outcome was the number of HR referrals per practice. Referrals from PAU practices were also analysed. We quantified the cost-effectiveness of the interventions and PAU using the incremental cost per additional true positive identified. Of 104 eligible practices, 54 consented to be randomised. Twenty-eight practices were randomised to low-intensity liaison and 26 practices were randomised to the high-intensity intervention. Two high-intensity practices withdrew. High-intensity practices referred more HR [incidence rate ratio (IRR) 2.2, 95% CI 0.9 to 5.1;p = 0.08], FEP (IRR 1.9, 95% CI 1.05 to 3.4;p = 0.04) and true-positive (IRR 2.0, 95% CI 1.1 to 3.6;p = 0.02) cases. High-intensity practices also referred more false-positive cases (IRR 2.6, 95% CI 1.3 to 5.0;p = 0.005); most (68%) of these were referred on to appropriate services. The total costs per true-positive referral in high-intensity practices were lower than those in low-intensity or PAU practices. Increasing the resources aimed at managing the primary–secondary care interface provided clinical and economic value.The Prospective Analysis of At-risk mental states and Transitions into psycHosis (PAATH) studyWe aimed to identify the proportion of individuals at HR who make the transition into FEP and to elucidate the common characteristics that can help identify them. Sixty help-seeking HR individuals aged 16–35 years were stratified into those who met the criteria for HR/FEP (true positives) according to the Comprehensive Assessment of At-Risk Mental States (CAARMS) and those who did not (false positives). HR participants were followed up over 2 years using a comprehensive interview schedule. A random sample of 60 healthy volunteers (HVs) matched for age (16–35 years), sex and geographical area underwent the same battery of questionnaires. Only 5% of our HR sample transitioned to a structured clinical diagnosis of psychosis over 2 years. HR individuals had a higher prevalence of moderate or severe depression, anxiety and suicidality than HVs. In fact, psychometric analyses in other population samples indicate that psychotic experiences measure the severe end of a common mental distress factor, consistent with these results. HR individuals also experienced significantly more traumatic events than HVs, but equivalent distress. Almost half of HR individuals had at least one Schneiderian first-rank symptom traditionally considered indicative of schizophrenia and 21.6% had more than one. HR individuals had very poor global functioning and low quality of life.ConclusionsThis National Institute for Health Research programme developed our understanding of the social epidemiology of psychosis. A new theory-based intervention doubled the identification of HR and FEP in primary care and was cost-effective. The HR mental state has much in common with depression and anxiety; very few people transitioned to full psychosis over 2 years, in line with other recent evidence. This new understanding will help people at HR receive appropriate services focused on their current mental state.Trial registrationThe primary LEGS trial is registered as ISRCTN70185866 and UKCRN ID 7036. The PAATH study is registered as UKCRN ID 7798.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.
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Rao, Sujatha, Lay Keow Lim, Lye Yin Poon, Spencer Yuen, Santha Pariyasami, Sarah Ann Tay, and Swapna Verma. "Poster #S160 REVIEW OF FALSE NEGATIVES WITH THE COMPREHENSIVE ASSESSMENT OF AT RISK MENTAL STATE (CAARMS) SCREENING." Schizophrenia Research 153 (April 2014): S147. http://dx.doi.org/10.1016/s0920-9964(14)70439-6.
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Fusar-Poli, P., R. Hobson, M. Raduelli, and U. Balottin. "Reliability and Validity of the Comprehensive Assessment of the at Risk Mental State, Italian Version (CAARMS-I)." Current Pharmaceutical Design 18, no. 4 (February 1, 2012): 386–91. http://dx.doi.org/10.2174/138161212799316118.
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Raballo, Andrea, Barnaby Nelson, Andrew Thompson, and Alison Yung. "The Comprehensive Assessment of At-Risk Mental States: From mapping the onset to mapping the structure." Schizophrenia Research 127, no. 1-3 (April 2011): 107–14. http://dx.doi.org/10.1016/j.schres.2010.12.021.
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Kounali, Daphne, Sarah Sullivan, Jon Heron, Jon McLeod, Mary Cannon, David Cotter, David Mongan, Glyn Lewis, Peter Jones, and Stanley Zammit. "M110. PREDICTING RISK OF PSYCHOSIS IN A GENERAL POPULATION SAMPLE." Schizophrenia Bulletin 46, Supplement_1 (April 2020): S176—S177. http://dx.doi.org/10.1093/schbul/sbaa030.422.
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Abstract Background At present clinical high-risk states for psychosis are determined by specialist mental health services using clinical tools such as the CAARMS, which largely rely on the detection of attenuated psychotic symptoms. However, the positive predictive value (PPV) of the CAARMS for transition to psychosis is only 25% in help seeking populations and as low as 5% in general population, non-help seeking samples. There is therefore a clear need to improve the prediction of psychotic disorder using other (non-symptom related) markers of risk. Our aim was to derive a risk prediction tool to determine risk of psychotic disorder using a large, population-based birth-cohort. Methods We used data from the ALSPAC birth cohort, with data on a comprehensive range of predictors ascertained from early childhood through early adulthood, and on psychotic disorder up to age 24 (imputed up to N≈7000 with any data on psychotic experiences). We use a two-stage risk prediction model, where different sets of predictors are used for outcomes of increasing severity. In the first stage, we predicted a clinical need for care in those who had self-reported psychotic-like experiences prior to age 17 years. We assumed that most of this need for care subsample would be help-seeking and that they therefore provide a more accessible risk-enriched sample for the second stage of our prediction model, where more difficult to measure predictors are included for estimating the risk of new onset psychotic disorder. Here we report on the first stage of our prediction model where we predict a clinical need for care (defined as presence of frequent and distressing interviewer-rated psychotic experiences) at age 17–24 years in participants who self-reported any psychotic-like experiences prior to age 17. The prediction set consisted of sixty-one features across 4 domains: socio-demographic (12 features); cognitive (10 features); non-psychotic psychopathology (24 features); behavioural (10 features). We used machine-learning methods for predictor selection and model fitting, employing resampling to assess and validate model calibration and discrimination. Results 13% of participants who self-reported psychotic experiences by age 17 were found to have a clinical need for care between ages 17–24, and 3.5% met criteria for newly ascertained psychotic disorder at 24 years. Use of two different machine learning methods for feature selection (random forests with a 10-fold cross-validation and elastic nets employing shrinkage) yielded similar results, although the elastic nets/ridge regression produced a more parsimonious model. The features selected included: adolescent self-harm, and childhood IQ, attention, processing speed and external locus of control. The AUC reduced very little compared to that of a model with 61 characteristics. This simpler model showed improved calibration and optimism-corrected predictive performance of AUC=0.73, sensitivity=0.75, specificity=0.60, and PPV=0.22. Discussion Our risk calculator is comparable in performance to those produced in studies of prodromal psychosis in high-risk samples. This first-stage model achieved promising predictive performance. We are currently developing a prognostic score for psychotic disorder in those with a clinical need for care and augment the predictor set with genetic, lipidomic and proteomic markers and further cognitive tests. We will then assess the model’s clinical utility and variation in predictive performance using linkage of ALSPAC data to clinical health care records with the aim to externally validate in other cohort studies.
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Molteni, Silvia, Giulia Spada, Eleonora Filosi, Martina Maria Mensi, Elena Ballante, Federica Ferro, Chiara Morabito, Melanie Iorio, and Umberto Balottin. "S21. CORRELATES AND TRANSITION RATE OF CHILDREN AND ADOLESCENTS WITH ATTENUATED PSYCHOTIC SYMPTOMS: FINDINGS FROM A LONGITUDINAL STUDY." Schizophrenia Bulletin 46, Supplement_1 (April 2020): S38. http://dx.doi.org/10.1093/schbul/sbaa031.087.
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Abstract Background The identification of people at high risk of developing psychosis is one of the most promising strategies to improve outcomes. However, in children and adolescents research on the high risk state and attenuated psychotic symptoms is still in its infancy and the clinical validity of at risk criteria appears understudied in this population (Tor et al. 2018). Thus, in this longitudinal cohort study, we aimed to: (1) characterize the clinical profile of APS adolescents, adolescents suffering from early onset psychosis (EOP) and adolescents with psychiatric disorders other than APS and EOP (non-APS) and (2) to calculate the cumulative transition rate to psychosis at follow-ups and investigate predictors of conversion to psychosis. Methods Help-seeking adolescents (aged 12–18 years) consecutively admitted to Child and Adolescent Neuropsychiatric inpatient and outpatient units of the IRCCS Mondino Foundation (Pavia, Italy) were recruited. The Comprehensive Assessment of At-Risk Mental State (CAARMS) was used in order to evaluate the presence of attenuated or full-blown psychotic symptoms. The final sample consisted of 31 EOP, 110 APS and 102 non-APS adolescents. At baseline patients underwent an extensive clinical and, in a subset, also neuropsychological assessment using standardized semi-structured interviews and instruments. All APS patients recruited until March 2019 were followed up for a median period of 33 months (range 4–81 months) and baseline measures were repeated (every 12 months). Transition to psychosis was defined according to the CAARMS criteria. Results At baseline, APS status was associated with poor socio-occupational functioning, especially social functioning (p<0.0001), as well as clinical severity (p<0.0001) as assessed by clinicians. APS adolescents reported a higher level of suicidality compared to non-APS (p=0.0003). The APS group displayed a higher number of comorbid disorders compared to the EOP and non-APS (p<0.0001) and was related to a wide range of disorders. APS and non-APS adolescents did not significantly differ in any of the neuropsychological test administered, although a worsening trend was observed between the two groups with lower scores in APS adolescents. The cumulative proportion of psychosis transition in the APS group was 13%, 17%, 24.2% and 26.8% at 1,2,3 and 4-year follow-ups, respectively. A high percentage of APS patients received at least one psychotropic medication (62.1%) during the follow-up period, especially antipsychotics (43.7%). Baseline lower global and social functioning (p=0.0092), higher clinical severity (p<0.0001), negative symptoms, lower Total IQ (p=0.02) and Processing Speed Index (p=0.03) were associated with transitioning to psychosis at follow-ups. Discussion Our findings support the validity and clinical relevance of the identification of APS in children and adolescents. Indeed, in our sample APS adolescents suffer from a variety of comorbidities and non-psychotic symptoms, present higher suicidality and are markedly impaired compared to non-psychotic adolescents not fulfilling APS criteria. Moreover, they show a cumulative transition risk to psychosis of 26.8% at 4 years that, although being lower than that found in adult samples, is still comparable to that of other conditions in preventive medicine.
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Molteni, Silvia, Eleonora Filosi, Martina Maria Mensi, Giulia Spada, Elena Ballante, Federica Ferro, Chiara Morabito, Melanie Iorio, and Umberto Balottin. "M27. FUNCTIONAL OUTCOME OF CHILDREN AND ADOLESCENTS WITH ATTENUATED PSYCHOTIC SYMPTOMS: RESULTS FROM A LONGITUDINAL STUDY." Schizophrenia Bulletin 46, Supplement_1 (April 2020): S144. http://dx.doi.org/10.1093/schbul/sbaa030.339.
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Abstract Background Assessing longitudinal functional outcomes, besides the risk of transition, seems important in underage population given the concerns about the use of at-risk criteria in this age range. Indeed, it has been highlighted that attenuated psychotic symptoms appear to be more common and transient than in adults and could, more often, represent normative experiences (Bartels-Velthuis et al. 2016; Schimmelmann et al. 2013). Thus, in this longitudinal cohort study, we aimed to evaluate socio-occupational functioning at follow-ups in children and adolescents with attenuated psychotic symptoms (APS) and to investigate potential clinical predictors of the functional outcome. Methods Help-seeking adolescents (aged 12–18 years) consecutively admitted to Child and Adolescent Neuropsychiatric inpatient and outpatient units of the IRCCS Mondino Foundation (Pavia, Italy) were recruited. The Comprehensive Assessment of At-Risk Mental State (CAARMS) was used in order to evaluate the presence of attenuated psychotic symptoms. The final sample consisted of 31adolescents suffering from early onset psychosis (EOP), 110 APS and 102 adolescents with psychiatric disorders other than APS and EOP (non-APS). At baseline patients underwent an extensive clinical and, in a subset, also neuropsychological assessment using standardized semi-structured interviews and instruments. All APS patients recruited until March 2019 were followed up for a median period of 33 months (range 4–81 months) and baseline measures were repeated (every 12 months). The level of functioning was defined through the Social and Occupational Functioning Assessment Scale (SOFAS). Results At 12 months and last visit follow-ups APS patients overall continued to display a significant impairment in socio-occupational functioning that persisted over time (baseline SOFAS average score 47.3±9.6, average 12-months follow-up 51.7±13.7, average last-visit follow-up SOFAS 51.6±11.5). Also APS adolescents that did not develop psychosis continued to display a significant impairment in socio-occupational functioning that persisted over time. Besides conversion status (p=0.04), a higher SOFAS (p=0.0026) and better social functioning (p=0.016) and total IQ (p=0.02) at baseline and not having a baseline diagnosis of anxiety disorders (generalized anxiety disorder, p=0.005 and panic disorder, p=0.003) significantly predicted socio-occupational functioning at follow-up. Discussion In line with previous literature in adults, besides the risk of transitioning, at follow-ups APS adolescents overall continued to display a significant impairment in socio-occupational functioning that persisted over time. These data further show that APS adolescents are truly in need of care and underscore the need, also and especially in adolescents, not to focus only on transition risk, as APS adolescents appear to be both at risk of conversion to psychosis but also of functional disability persistent over time. Thus, preventive interventions should not only target emerging psychosis, but also improving APS social and global functional impairment that already at baseline seems to be linked with such a disabling outcome. In APS children and adolescents a multidimensional treatment plan including careful monitoring not only for a potential progression but also psychological interventions aiming at improving functioning is strongly recommended
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Dixon, Mark A., Steven M. Hyer, and David L. Snowden. "Suicide in primary care: How to screen and intervene." International Journal of Psychiatry in Medicine 56, no. 5 (September 2021): 344–53. http://dx.doi.org/10.1177/00912174211042435.
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Suicide is significant public health concern within the United States. Research results are mixed about the effectiveness of universal screening and interventions with patients who are at-risk for suicide. Primary care is a logical intervention point to mitigate risk among patients in each of these areas. The Department of Veterans Affairs and Department of Defense have developed comprehensive guidelines for the assessment and management of suicidal patients. This approach involves specific screening tools, risk stratification by categories and interventions used by clinicians to help reduce risk levels in their patients. This article aims to provide a model, built on the principles of these guidelines, which primary care physicians can use to identify, assess and intervene with patients who are at-risk for suicide.
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Krakauer, K., B. H. Ebdrup, B. Y. Glenthøj, J. M. Raghava, D. Nordholm, L. Randers, E. Rostrup, and M. Nordentoft. "Patterns of white matter microstructure in individuals at ultra-high-risk for psychosis: associations to level of functioning and clinical symptoms." Psychological Medicine 47, no. 15 (May 3, 2017): 2689–707. http://dx.doi.org/10.1017/s0033291717001210.
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BackgroundIndividuals at ultra-high-risk (UHR) for psychosis present with emerging symptoms and decline in functioning. Previous univariate analyses have indicated widespread white matter (WM) aberrations in multiple brain regions in UHR individuals and patients with schizophrenia. Using multivariate statistics, we investigated whole brain WM microstructure and associations between WM, clinical symptoms, and level of functioning in UHR individuals.MethodsForty-five UHR individuals and 45 matched healthy controls (HCs) underwent magnetic resonance diffusion tensor imaging (DTI) at 3 Tesla. UHR individuals were assessed with the Comprehensive Assessment of At-Risk Mental States, Scale for the Assessment of Negative Symptoms, and Social and Occupational Functioning Assessment Scale. Partial least-squares correlation analysis (PLSC) was used as statistical method.ResultsPLSC group comparisons revealed one significant latent variable (LV) accounting for 52% of the cross-block covariance. This LV indicated a pattern of lower fractional anisotropy (FA), axial diffusivity (AD), and mode of anisotropy (MO) concomitant with higher radial diffusivity (RD) in widespread brain regions in UHR individuals compared with HCs. Within UHR individuals, PLSC revealed five significant LVs associated with symptoms and level of functioning. The first LV accounted for 31% of the cross-block covariance and indicated a pattern where higher symptom score and lower level of functioning correlated to lower FA, AD, MO, and higher RD.ConclusionsUHR individuals demonstrate complex brain patterns of WM abnormalities. Despite the subtle psychopathology of UHR individuals, aberrations in WM appear associated with positive and negative symptoms as well as level of functioning.
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Chu, Angel On Ki, Wing Chung Chang, Sherry Kit Wa Chan, Edwin Ho Ming Lee, Christy Lai Ming Hui, and Eric Yu Hai Chen. "Comparison of cognitive functions between first-episode schizophrenia patients, their unaffected siblings and individuals at clinical high-risk for psychosis." Psychological Medicine 49, no. 11 (September 18, 2018): 1929–36. http://dx.doi.org/10.1017/s0033291718002726.
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AbstractBackgroundCognitive impairment is a core feature of schizophrenia and has been observed in both familial (FHR) and clinical high-risk (CHR) samples. Nonetheless, there is a paucity of research directly contrasting cognitive profiles in these two high-risk states and first-episode schizophrenia. This study aimed to compare cognitive functions in patients with first-episode schizophrenia-spectrum disorder (FES), their unaffected siblings (FHR), CHR individuals and healthy controls.MethodA standardized battery of cognitive assessments was administered to 69 FES patients, 71 help-seeking CHR individuals without family history of psychotic disorder, 50 FHR participants and 68 controls. FES and CHR participants were recruited from territory-wide early intervention service for psychosis in Hong Kong. CHR status was ascertained using Comprehensive Assessment of At-Risk Mental State.ResultsAmong four groups, FES patients displayed the largest global cognitive impairment and had medium-to-large deficits across all cognitive tests relative to controls. CHR and FHR participants significantly underperformed in most cognitive tests than controls. Among various cognitive tests, digit symbol coding demonstrated the greatest magnitude of impairment in FES and CHR groups compared with controls. No significant difference between two high-risk groups was observed in global cognition and all individual cognitive tests except digit symbol coding which showed greater deficits in CHR than in FHR participants.ConclusionClinical and familial risk groups experienced largely comparable cognitive impairment that was intermediate between FES and controls. Digit symbol coding may have the greatest discriminant capacity in distinguishing FES and CHR from healthy controls, and between two high-risk samples.
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Hernández, Andrés, Minxuan Lan, Neil J. MacKinnon, Adam J. Branscum, and Diego F. Cuadros. "“Know your epidemic, know your response”: Epidemiological assessment of the substance use disorder crisis in the United States." PLOS ONE 16, no. 5 (May 26, 2021): e0251502. http://dx.doi.org/10.1371/journal.pone.0251502.
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The United States (U.S.) is currently experiencing a substance use disorders (SUD) crisis with an unprecedented magnitude. The objective of this study was to recognize and characterize the most vulnerable populations at high risk of SUD mortality in the U.S., and to identify the locations where these vulnerable population are located. We obtained the most recent available mortality data for the U.S. population aged 15–84 (2005–2017) from the Centers for Diseases and Prevention (CDC). Our analysis focused on the unintentional substance poisoning to estimate SUD mortality. We computed health-related comorbidities and socioeconomic association with the SUD distribution. We identified the most affected populations and conducted a geographical clustering analysis to identify places with increased concentration of SUD related deaths. From 2005–2017, 463,717 SUD-related deaths occurred in the United States. White population was identified with the highest SUD death proportions. However, there was a surge of the SUD epidemic in the Black male population, with a sharp increase in the SUD-related death rate since 2014. We also found that an additional average day of mental distress might increase the relative risk of SUD-related mortality by 39%. The geographical distribution of the epidemic showed clustering in the West and Mid-west regions of the U.S. In conclusion, we found that the SUD epidemic in the U.S. is characterized by the emergence of several micro-epidemics of different intensities across demographic groups and locations within the country. The comprehensive description of the epidemic presented in this study could assist in the design and implementation of targeted policy interventions for addiction mitigation campaigns.
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Polcher, Kelly, and Susan Calloway. "Addressing the Need for Mental Health Screening of Newly Resettled Refugees." Journal of Primary Care & Community Health 7, no. 3 (March 4, 2016): 199–203. http://dx.doi.org/10.1177/2150131916636630.
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Background and Purpose: Refugees resettling to the United States are at increased risk for mental health disorders, which can lead to difficulty with adaptation and poor health outcomes. Standardized mental health screening of refugees is often neglected at primary care and community health clinics. A pilot project aimed to initiate early mental health screening for newly resettled adult refugees was implemented at a community health center in Fargo, North Dakota. Methods: Current refugee screening processes were evaluated to determine appropriate timing for refugee mental health screening. This took into consideration time, staffing, interpreter availability and the refugee “honeymoon” phase following resettlement. The Refugee Health Screener–15 (RHS-15) was identified as an efficient, valid, and reliable tool for assessing emotional distress in this population and was integrated into refugee health screening practices. Results: The RHS-15 was administered to 178 adult refugees with arrival dates between August 1, 2013 and July 31, 2014. Of those screened, 51 (28.6%) screened positive for risk of emotional distress. Follow-up with primary care provider was completed with 30 (59%) of those who screened positive. Half (15) requested mental health treatment. Although the largest group of refugees during this period of time were resettling from Bhutan, refugees from Iraq had greater incidence of positive screening compared with those from Bhutan. Refugees from Iraq were also found to have significantly higher scores on the RHS-15. Conclusions: Although there are some challenges to implementing a standardized mental health screening for refugees, this pilot reiterates the need for standardized mental health screening of refugees. Routine mental health screening should be a part of the overall comprehensive health assessment provided to refugees nationwide. Considerations should be taken in regards to how refugees from Iraq have even greater risk of mental health disorders compared to other refugee groups.
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Pelizza, L., A. Raballo, E. Semrov, S. Azzali, S. Garlassi, F. Paterlini, I. Scazza, et al. "The Regional Project for the Treatment of Early Psychosis Implemented in the Reggio Emilia Mental Health Department: Preliminary Data From a 2-Year Follow-Up." European Psychiatry 41, S1 (April 2017): S275. http://dx.doi.org/10.1016/j.eurpsy.2017.02.111.
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IntroductionSeveral studies had shown the effectiveness of combined interventions in the treatment of young patients with a first episode of psychosis (FEP). More controversial are the evidence about the stability of the therapeutic outcomes in individuals ultra-high risk (UHR).AimsTo describe the regional project for the treatment of early psychosis implemented in the Reggio Emilia Mental Health Department (ReMHD) and also to report preliminary data from a 2-year follow-up.MethodsIn addition with the treatment as usual (TAU), treatment implemented within the regional project for early psychosis (PREP) in the ReMHD comprises the following:– pharmacotherapy according to international guidelines;– a phase-specific individualized Cognitive-Behavioural therapy;– a psycho-educational intervention addressed to family members;– a case management recovery-oriented.Action strategies are preceded by the administration of Reggio Emilia at Risk mental States Battery Checklist as a comprehensive assessment useful to define the severity and the quality of symptoms, the degree of functioning, the subjectivity of suffering, and the perceived quality of life.ResultsThe assessment carried out after 24 months of continuous treatment showed significant improvements in both the psychotic symptoms (positive, negative and general psychopathology PANSS subscales) that the daily functioning (SOFAS).ConclusionsAlthough our sample is still relatively small (n = 50) to draw definitive conclusions, it is emerging the good prognosis for UHR individuals and patients with FEP submitted on PREP treatment implemented in the ReMHD.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Mongan, David, Melanie Föcking, Colm Healy, Subash Raj Susai, Gerard Cagney, Mary Cannon, Stanley Zammit, et al. "T21. DEVELOPMENT OF PROTEOMIC PREDICTION MODELS FOR OUTCOMES IN THE CLINICAL HIGH RISK STATE AND PSYCHOTIC EXPERIENCES IN ADOLESCENCE: MACHINE LEARNING ANALYSES IN TWO NESTED CASE-CONTROL STUDIES." Schizophrenia Bulletin 46, Supplement_1 (April 2020): S238—S239. http://dx.doi.org/10.1093/schbul/sbaa029.581.
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Abstract Background Individuals at clinical high risk (CHR) of psychosis have an approximately 20% probability of developing psychosis within 2 years, as well as an associated risk of non-psychotic disorders and functional impairment. People with subclinical psychotic experiences (PEs) are also at risk of future psychotic and non-psychotic disorders and decreased functioning. It is difficult to accurately predict outcomes in individuals at risk of psychosis on the basis of symptoms alone. Biomarkers for accurate prediction of outcomes could inform the clinical management of this group. Methods We conducted two nested case-control studies. We employed discovery-based proteomic methods to analyse protein expression in baseline plasma samples in EU-GEI and age 12 plasma samples in ALSPAC using liquid chromatography mass spectrometry. Differential expression of quantified proteomic markers was determined by analyses of covariance (with false discovery rate of 5%) comparing expression levels for each marker between those who did not and did not develop psychosis in Study 1 (adjusting for age, gender, body mass index and years in education), and between those who did and did not develop PEs in Study 2 (adjusting for gender, body mass index and maternal social class). Support vector machine algorithms were used to develop models for prediction of transition vs. non-transition (as determined by the Comprehensive Assessment of At Risk Mental States) and poor vs. good functional outcome at 2 years in Study 1 (General Assessment of Functioning: Disability subscale score </=60 vs. >60). Similar algorithms were used to develop a model for prediction of PEs vs. no PEs at age 18 in Study 2 (as determined by the Psychosis Like Symptoms Interview). Results In Study 1, 35 of 166 quantified proteins were significantly differentially expressed between CHR participants who did and did not develop psychosis. Functional enrichment analysis provided evidence for particular implication of the complement and coagulation cascade (false discovery rate-adjusted Fisher’s exact test p=2.23E-21). Using 65 clinical and 166 proteomic features a model demonstrated excellent performance for prediction of transition status (area under the receiver-operating curve [AUC] 0.96, positive predictive value [PPV] 83.0%, negative predictive value [NPV] 93.8%). A model based on the ten most predictive proteins accurately predicted transition status in training (AUC 0.96, PPV 87.5%, NPV 95.8%) and withheld data (AUC 0.92, PPV 88.9%, NPV 91.4%). A model using the same 65 clinical and 166 proteomic features predicted 2-year functional outcome with AUC 0.72 (PPV 67.6%, NPV 47.6%). In Study 2, 5 of 265 quantified proteins were significantly differentially expressed between participants who did and did not report PEs at age 18. A model using 265 proteomic features predicted PEs at age 18 with AUC 0.76 (PPV 69.1%, NPV 74.2%). Discussion With external validation, models incorporating proteomic data may contribute to improved prediction of clinical outcomes in individuals at risk of psychosis.
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Wang, Hung-Yu, Joh-Jong Huang, Shu-Fang Su, Sheng-Hao Hsu, Li-Shiu Chou, and Frank Huang-Chih Chou. "From folk therapy to evidence-based psychiatry practice: The benefit of evidence-based psychiatry in treatment-naive psychotic patients." International Journal of Social Psychiatry 66, no. 6 (May 28, 2020): 593–99. http://dx.doi.org/10.1177/0020764020924698.
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Background: As Taiwan’s Mental Health Act (MHA) clearly states that the human rights and legal rights of psychotic patients should be respected and guaranteed; however, a temple asylum violates the law in the 21st century. Hundreds of patients were constrained in the asylum for years without consent. Because of outbreak of infectious diseases, patients were evacuated from the asylum by the official intervention. Aims: To evaluate the outcomes of these patients from folk therapy to conventional treatment. Method: The study recruited the drug-naive psychotic patients constrained in an asylum for decades. Before and after the formal treatment, 253 patients were diagnosed with schizophrenia and other psychotic disorders with assessment of using the Mini Positive and Negative Syndrome Scale (Mini-PANSS) and Comprehensive Occupational Therapy Evaluation (COTE) scale. In addition, family function, self-care ability and nutritional status were also evaluated. Results: The initial data show the improvement in psychotic symptoms and occupational function in these patients. Furthermore, the ratio of patients who were classified as being at risk for malnutrition was decreased by 21.7% after treatment. There was no statistically significant difference in self-care ability before and after treatment. Conclusion: The psychotic symptoms and occupational function of these patients were improved after the formal treatment compared to the folk therapy. The care model for the psychotic patients in the temple asylum should be more thoroughly discussed in consideration of the medical ethics principles.
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Tanabe, Paula, Ted Wun, Victoria Thornton, Knox Todd, and John S. Lyons. "Development of a Decision Support Tool to Guide Management of Adults with Sickle Cell Disease: The Emergency Department Sickle Cell Assessment of Strengths and Needs (ED-SCANS)." Blood 114, no. 22 (November 20, 2009): 1413. http://dx.doi.org/10.1182/blood.v114.22.1413.1413.
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Abstract Abstract 1413 Poster Board I-436 Objectives: There are relatively few centers across the United States that either specialize in SCD care or have day hospitals where patients can be evaluated and urgently treated for acute pain crises. While most patients come to the ED for management of an acute pain crisis, SCD patients are at risk for many life-threatening complications. Most patients with SCD require an ED visit at some point. The complexity of SCD warrants a comprehensive assessment in the emergency department. While it may be challenging to conduct such an assessment in the ED, a succinct decision support tool may help guide clinicians in the performance of such an assessment. The benefits of such an assessment would identify unmet patient needs and help guide ED management and referrals. The goal of this project was to develop a brief, easy to use tool that guides the emergency clinicians in the identification of such needs and aid in accomplishing the following goals: 1) rapidly and aggressively manage ED pain, 2) identify other life-threatening conditions, 3) decrease hospital admission rates, 4) decrease return visits to the ED, 5) identify and increase the number of referrals made from the ED setting, and 6) increase both patient and clinician satisfaction with the ED experience. Methods: A series of seven clinician and patient focus groups were conducted in four cities across the United States (Chicago, Denver, Durham, and New York) to obtain key stakeholder input. Visits at three SCD centers of excellence (University of Colorado Denver, Duke University, Virginia Commonwealth University) were conducted, a literature search was conducted, and the PI attended SCD clinics to observe practice patterns with sickle cell experts at the University of Illinois and University of Chicago sickle cell clinics. Focus group data was analyzed using qualitative methods and is reported elsewhere. All data was synthesized and a draft tool was created and reviewed by outside experts. Revisions were made. Results: The following six key decisions were identified as being critical in achieving the tools aims: (1) what is the correct triage level, (2) how should pain be treated, (3) does the patient require a diagnostic work-up, (4) should the patient be admitted to the hospital, (5) if discharged home, is there a need for analgesic prescriptions, and (6) does the patient need a referral to a sickle cell expert or mental health or social services? Supporting data elements for each decision were also identified and included as part of the tool which will be formulated into an easy to use algorithm. Data elements include key history and physical indicators of a potential high risk situation necessitating further evaluation, pain assessment and history of analgesic use, relationship with a sickle cell expert, ED and hospital utilization history, and evaluation of psychosocial needs (self-report of anxiety or depression, work/employment status, home situation). Conclusions: Critical decisions and associated supporting elements to facilitate ED management were identified. Future work will involve finalizing and testing this communimetric tool, which will guide emergency department evaluation and management, as well as guide analgesic management in real time. Disclosures: Tanabe: NIH, and Mayday Fund: Research Funding. Todd: NIH: Research Funding; Xanodyne: Consultancy; Merck: Consultancy; Alpharma: Consultancy; Abbott: Consultancy; Baxter Healthcare: Consultancy; Fralex Therapeutics: Consultancy; Intranasal Therapeutics: Consultancy; Baxter Health: Research Funding; Roxro: Consultancy.
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Attridge, Mark D., Russell C. Morfitt, David J. Roseborough, and Edward R. Jones. "Internet-Based Cognitive-Behavioral Therapy for College Students With Anxiety, Depression, Social Anxiety, or Insomnia: Four Single-Group Longitudinal Studies of Archival Commercial Data and Replication of Employee User Study." JMIR Formative Research 4, no. 7 (July 23, 2020): e17712. http://dx.doi.org/10.2196/17712.
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Background The growing behavioral health needs of college students have resulted in counseling centers reporting difficulties in meeting student demand. Objective This study aims to test the real-world voluntary use by college students of 4 digital, self-directed mental health modules based on a cognitive behavioral therapy clinical model. The findings were also compared with those of employee users. Methods Archival operational data from Learn to Live were extracted for student users at 4 colleges and universities in the Midwest region of the United States (N=951). The inclusion criteria were having clinical symptoms at established levels of moderate or higher severity and the use of 2 or more of the 8 lessons of a program within a 6-month period. Unique users in each program included 347 for depression; 325 for stress, anxiety, and worry; 203 for social anxiety; and 76 for insomnia. Paired t tests (two-tailed) compared the average level of change over time on a standardized measure of clinical symptoms appropriate to each program. Cohen d statistical effect sizes were calculated for each program. Potential moderator factors (age, gender, preliminary comprehensive assessment, number of lessons, duration, live coach support, and live teammate support) were tested together in repeated measures analysis of variance models with covariates in the full sample. Follow-up survey data (n=136) were also collected to explore user satisfaction and outcomes. Select data from another study of the same 4 programs by employee users meeting the same criteria (N=707) were examined for comparison. Results The percentage of users who improved to a clinical status of no longer being at risk after program use was as follows: stress, anxiety, and worry program (149/325, 45.8%); insomnia program (33/76, 43.4%), depression program (124/347, 35.7%); and social anxiety program (45/203, 22.2%). Significant improvements (all P<.001) over time were found in the mean scores for the clinical measures for each program: stress, anxiety, and worry (t324=16.21; d=1.25); insomnia (t75=6.85; d=1.10); depression (t346=12.71; d=0.91); and social anxiety (t202=8.33; d=0.80). Tests of the moderating factors across programs indicated that greater improvement was strongly associated with the use of more lessons and it also differed by program, by gender (males demonstrated more improvement than females), and by the use of live support (particularly coaching). Analyses of survey data found high satisfaction, improved academic outcomes, and successful integration into the university counseling ecosystem. The operational profile and outcomes of the college students were also similar to those of employee users of the same programs from our other study of employee users. Thus, this study provides a replication. Conclusions Self-directed internet-based cognitive behavioral therapy mental health modules are promising as a supplement to traditional in-person counseling services provided by college counseling centers.
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Kusuma Wijayanti, Puspita Adhi, and Surya Cahyadi. "Antecedents-Consequences Modification to Decrease Hyper-activity and Improve Attention of Child with ADHD." JPUD - Jurnal Pendidikan Usia Dini 13, no. 2 (November 30, 2019): 232–48. http://dx.doi.org/10.21009/jpud.132.03.
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The prevalence of ADHD children increases every year. Some researchers have shown that psychosocial behavior therapy (antecedents-consequences modification) was effective to decrease hyperactivity and increase attention to ADHD children. This study aims to find out the effectiveness of antecedents-consequences modification by parents and teachers to decrease hyperactivity and increase attention to a 6 years old boy with ADHD. The study was a single case experimental design. Psychosocial behavior therapy has been used with antecedents-consequences modification. The antecedents-consequences modification was applied by teacher at school and parents at home. Data were analyzed using Wilcoxon Signed Rank Test. Results showed that there’s a significant decrease of hyperactivity behavior and significant increase of doing his assignment both at school and also at home. Not only about the content of behavior therapy itself, but how to give the therapy is important. Parents and teacher should do the therapy consistently, immediately, specifically and saliency to reach the target of intervention.
Keywords: ADHD Children, Antecedents, Consequences, Modification
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Mensi, Martina Maria, Chiara Rogantini, Renata Nacinovich, Anna Riva, Livio Provenzi, Matteo Chiappedi, Umberto Balottin, and Renato Borgatti. "Clinical features of adolescents diagnosed with eating disorders and at risk for psychosis." European Psychiatry 63, no. 1 (2020). http://dx.doi.org/10.1192/j.eurpsy.2020.80.
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Abstract Background. The presence of subthreshold psychotic symptoms in adolescents with eating disorders is poorly described. This study provides a detailed characterization of adolescents affected by eating disorders in the absence or presence of subthreshold psychotic symptoms, taking into account a wide set of sociodemographic, psychological, and clinical variables. Methods. Ninety-four adolescents diagnosed with eating disorders were interviewed, focusing on clinical anamnesis and sociodemographic data collection. The Comprehensive Assessment of At-Risk Mental States (CAARMS) was used to assess the presence (HR+) or absence (HR−) of subthreshold psychosis. The clinicians completed a questionnaire on eating disorders severity, whereas patients provided self-report measures of global social functioning and psychological symptoms associated with eating disorders. Results. Attenuated psychotic symptoms were highly frequent (84% of subjects). HR+ patients experienced more frequently purging behaviors and dysmorphophobia and received a greater amount of antipsychotic drugs. Compared to HR− counterparts, HR+ patients reported higher eating disorders severity and psychological symptoms (i.e., ineffectiveness, interpersonal and affective problems) associated with eating disorders. Finally, a significant correlation between global social functioning and eating disorders severity emerged only for HR− subjects. Conclusions. These descriptive data are warranted to identify a potential psychotic core in eating disorders, mainly concerning body image and weight as well as specific psychological features. The availability of reliable and valid markers of risk can further increase our capacity to detect the early emergence of psychosis in adolescents with eating disorders, whose outcome might be worsened by the presence of psychotic symptoms.
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Catalan, Ana, Stefania Tognin, Matthew J. Kempton, Daniel Stahl, Gonzalo Salazar de Pablo, Barnaby Nelson, Christos Pantelis, et al. "Relationship between jumping to conclusions and clinical outcomes in people at clinical high-risk for psychosis." Psychological Medicine, October 6, 2020, 1–9. http://dx.doi.org/10.1017/s0033291720003396.
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Abstract Background Psychosis is associated with a reasoning bias, which manifests as a tendency to ‘jump to conclusions’. We examined this bias in people at clinical high-risk for psychosis (CHR) and investigated its relationship with their clinical outcomes. Methods In total, 303 CHR subjects and 57 healthy controls (HC) were included. Both groups were assessed at baseline, and after 1 and 2 years. A ‘beads’ task was used to assess reasoning bias. Symptoms and level of functioning were assessed using the Comprehensive Assessment of At-Risk Mental States scale (CAARMS) and the Global Assessment of Functioning (GAF), respectively. During follow up, 58 (16.1%) of the CHR group developed psychosis (CHR-T), and 245 did not (CHR-NT). Logistic regressions, multilevel mixed models, and Cox regression were used to analyse the relationship between reasoning bias and transition to psychosis and level of functioning, at each time point. Results There was no association between reasoning bias at baseline and the subsequent onset of psychosis. However, when assessed after the transition to psychosis, CHR-T participants showed a greater tendency to jump to conclusions than CHR-NT and HC participants (55, 17, 17%; χ2 = 8.13, p = 0.012). There was a significant association between jumping to conclusions (JTC) at baseline and a reduced level of functioning at 2-year follow-up in the CHR group after adjusting for transition, gender, ethnicity, age, and IQ. Conclusions In CHR participants, JTC at baseline was associated with adverse functioning at the follow-up. Interventions designed to improve JTC could be beneficial in the CHR population.
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de Jong, Yvonne, Cornelis L. Mulder, Albert Boon, Elias Coenders, and Mark van der Gaag. "Cross Validation of the Prodromal Questionnaire 16-Item Version in an Adolescent Help-Seeking Population." Schizophrenia Bulletin Open 1, no. 1 (January 1, 2020). http://dx.doi.org/10.1093/schizbullopen/sgaa033.
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Abstract The Prodromal Questionnaire 16-item version (PQ-16) is used as a screener in the early detection of psychosis. We wished to cross-validate it in a help-seeking population of adolescents aged 12–17 who had been referred for assessment and treatment to an outpatient Center for Child and Adolescence Psychiatry (CCAP). To examine the psychometric properties of the PQ-16 for adolescents, we used reliability analysis and receiver-operating-characteristic (ROC) curves. The internal consistency of the 16-item version was good, with Chronbach’s α = 0.84. A cutoff of 7 or more items marked as true, showed acceptable sensitivity (.77) and specificity (.55). Half (51.3%) of the above cutoff sample were classified by the Comprehensive Assessment of At-Risk Mental States (CAARMS) assessment as having Ultra-High Risk (UHR) status or as having reached the psychosis threshold. Differentiation between boys and girls showed that the use of distress scores improved sensitivity and specificity values for girls but worsened them for boys. When a cutoff score of 7 or more items marked as true is used, the PQ-16 is a feasible instrument with acceptable screening properties for UHR and psychosis in boys and girls aged 12–17 attending a CCAP.
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Yokuşoğlu, Çağdaş, Mete Ercis, Nuran Çağlar, Ömer Aydemir, and Alp Üçok. "Reliability and validity of the Turkish version of comprehensive assessment of at risk mental states." Early Intervention in Psychiatry, August 4, 2020. http://dx.doi.org/10.1111/eip.13014.
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Lho, Silvia Kyungjin, Sanghoon Oh, Sun‐Young Moon, Woori Choi, Minah Kim, Tae Young Lee, and Jun Soo Kwon. "Reliability and validity of the Korean version of the comprehensive assessment of at‐risk mental states." Early Intervention in Psychiatry, February 4, 2021. http://dx.doi.org/10.1111/eip.13123.
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Chesters, Robert A., Fiona Pepper, Celia Morgan, Jonathan D. Cooper, Oliver D. Howes, Anthony C. Vernon, and James M. Stone. "Brain volume in chronic ketamine users — relationship to sub-threshold psychotic symptoms and relevance to schizophrenia." Psychopharmacology, July 6, 2021. http://dx.doi.org/10.1007/s00213-021-05873-0.
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Abstract Rationale Ketamine may model aspects of schizophrenia arising through NMDA receptor activity deficits. Although acute ketamine can induce effects resembling both positive and negative psychotic symptoms, chronic use may be a closer model of idiopathic psychosis. Objectives We tested the hypotheses that ketamine users had lower brain volumes, as measured using MRI, and greater sub-threshold psychotic symptoms relative to a poly-drug user control group. Methods Ketamine users (n = 17) and poly-drug using controls (n = 19) were included in the study. All underwent volumetric MRI imaging and measurement of sub-threshold psychotic symptoms using the Comprehensive Assessment of At-Risk Mental State (CAARMS). Freesurfer was used to analyse differences in regional brain volume, cortical surface area and thickness between ketamine users and controls. The relationship between CAARMS ratings and brain volume was also investigated in ketamine users. Results Ketamine users were found to have significantly lower grey matter volumes of the nucleus accumbens, caudate nucleus, cerebellum and total cortex (FDR p < 0.05; Cohen’s d = 0.36–0.75). Within the cortex, ketamine users had significantly lower grey matter volumes within the frontal, temporal and parietal cortices (Cohen’s d 0.7–1.31; FDR p < 0.05). They also had significantly higher sub-threshold psychotic symptoms (p < 0.05). Frequency of ketamine use showed an inverse correlation with cerebellar volume (p < 0.001), but there was no relationship between regional brain volumes and sub-threshold psychotic symptoms. Conclusions Chronic ketamine use may cause lower grey matter volumes as well as inducing sub-threshold psychotic symptoms, although these likely arise through distinct mechanisms.
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Pozza, Andrea, Sandro Domenichetti, and Davide Dèttore. "Cognitive behavioural therapy for worry in young individuals with at-risk mental states: a preliminary investigation." Cognitive Behaviour Therapist 12 (2019). http://dx.doi.org/10.1017/s1754470x19000229.
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Abstract Cognitive behavioural therapy (CBT) is a first-line strategy in reducing or delaying risk of transition to psychosis among young individuals with at-risk mental states (ARMS). However, there is little knowledge about its effects on other outcomes associated with ARMS. No study on CBT for ARMS has assessed worry, an important process associated with this condition. The present study investigated changes in worry at immediate post-treatment and 14-month follow-up after CBT for young individuals with ARMS seeking psychiatric care in mental health services. Thirty-seven young individuals (mean age = 26 years, SD = 6.07; 22.20% female) seeking psychiatric care in mental health services and classified as reporting ARMS through the Comprehensive Assessment of At-Risk Mental States were included. The Positive And Negative Syndrome Scales (PANSS) and Penn State Worry Questionnaire (PSWQ) were administered at baseline, post-treatment, and follow-up. CBT consisted of 30 weekly individual 1-hour sessions based on a validated CBT for ARMS manual enriched with components targeting worry [psychoeducation, problem-solving, (meta)cognitive restructuring, behavioural experiments]. Seven participants (18.91%) at follow-up had cumulatively made transition to psychosis. Repeated measures ANOVA with post-hoc pairwise comparisons showed significant changes in PSWQ scores from baseline to post-treatment and from baseline to follow-up; PSWQ scores remained stable from post-treatment to follow-up. This is the first study investigating changes in worry after CBT for ARMS, which appears to be a promising strategy also for this outcome. Future research with a larger sample size and control group may determine whether changes in worry are also associated with reduced transition risk. Key learning aims (1) To understand CBT evidence and procedures for young individuals with ARMS. (2) To reflect on the current limitations in the literature on CBT for ARMS. (3) To understand the importance and clinical implications of assessing worry in ARMS. (4) To focus on changes in worry as an outcome after CBT for ARMS. (5) To reflect on future research directions on the role of worry in CBT for ARMS.
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Poletti, Michele, Silvia Azzali, Federica Paterlini, Sara Garlassi, Ilaria Scazza, Luigi Rocco Chiri, Simona Pupo, Andrea Raballo, and Lorenzo Pelizza. "Familiarity for Serious Mental Illness in Help-Seeking Adolescents at Clinical High Risk of Psychosis." Frontiers in Psychiatry 11 (January 8, 2021). http://dx.doi.org/10.3389/fpsyt.2020.552282.
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Aim: Ultrahigh-risk (UHR) individuals have an increased vulnerability to psychosis because of accumulating environmental and/or genetic risk factors. Although original research examined established risk factors for psychosis in the UHR state, these findings are scarce and often contradictory. The aims of this study were (a) to investigate the prevalence of severe mental illness (SMI) in family members of distinct subgroups of adolescents identified through the UHR criteria [i.e., non-UHR vs. UHR vs. first-episode psychosis (FEP)] and (b) to examine any relevant associations of family vulnerability and genetic risk and functioning deterioration (GRFD) syndrome with clinical and psychopathological characteristics in the UHR group.Methods: Adolescents (n = 147) completed an ad hoc sociodemographic/clinical schedule and the Comprehensive Assessment of At-Risk Mental States to investigate the clinical status.Results: More than 60% UHR patients had a family history of SMI, and approximately a third of them had at least a first-degree relative with psychosis or other SMI. A GRFD syndrome was detected in ~35% of UHR adolescents. GRFD adolescents showed baseline high levels of positive symptoms (especially non-bizarre ideas) and emotional disturbances (specifically, observed inappropriate affect).Conclusions: Our results confirm the importance of genetic and/or within-family risk factors in UHR adolescents, suggesting the crucial need of their early detection, also within the network of general practitioners, general hospitals, and the other community agencies (e.g., social services and school).
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Poletti, Michele, Silvia Azzali, Federica Paterlini, Sara Garlassi, Ilaria Scazza, Luigi Rocco Chiri, Simona Pupo, Andrea Raballo, and Lorenzo Pelizza. "Familiarity for Serious Mental Illness in Help-Seeking Adolescents at Clinical High Risk of Psychosis." Frontiers in Psychiatry 11 (January 8, 2021). http://dx.doi.org/10.3389/fpsyt.2020.552282.
Full textAbstract:
Aim: Ultrahigh-risk (UHR) individuals have an increased vulnerability to psychosis because of accumulating environmental and/or genetic risk factors. Although original research examined established risk factors for psychosis in the UHR state, these findings are scarce and often contradictory. The aims of this study were (a) to investigate the prevalence of severe mental illness (SMI) in family members of distinct subgroups of adolescents identified through the UHR criteria [i.e., non-UHR vs. UHR vs. first-episode psychosis (FEP)] and (b) to examine any relevant associations of family vulnerability and genetic risk and functioning deterioration (GRFD) syndrome with clinical and psychopathological characteristics in the UHR group.Methods: Adolescents (n = 147) completed an ad hoc sociodemographic/clinical schedule and the Comprehensive Assessment of At-Risk Mental States to investigate the clinical status.Results: More than 60% UHR patients had a family history of SMI, and approximately a third of them had at least a first-degree relative with psychosis or other SMI. A GRFD syndrome was detected in ~35% of UHR adolescents. GRFD adolescents showed baseline high levels of positive symptoms (especially non-bizarre ideas) and emotional disturbances (specifically, observed inappropriate affect).Conclusions: Our results confirm the importance of genetic and/or within-family risk factors in UHR adolescents, suggesting the crucial need of their early detection, also within the network of general practitioners, general hospitals, and the other community agencies (e.g., social services and school).
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Wenneberg, C., B. Y. Glenthøj, L. B. Glenthøj, B. Fagerlund, K. Krakauer, T. D. Kristensen, C. Hjorthøj, et al. "Baseline measures of cerebral glutamate and GABA levels in individuals at ultrahigh risk for psychosis: Implications for clinical outcome after 12 months." European Psychiatry 63, no. 1 (2020). http://dx.doi.org/10.1192/j.eurpsy.2020.77.
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Abstract Background. Cerebral glutamate and gamma-aminobutyric acid (GABA) levels might predict clinical outcome in individuals at ultrahigh risk (UHR) for psychosis but have previously primarily been investigated in smaller cohorts. We aimed to study whether baseline levels of glutamate and GABA in anterior cingulate cortex (ACC) and glutamate in thalamus could predict remission status and whether baseline metabolites differed in the remission versus the nonremission group. We also investigated the relationship between baseline metabolite levels and severity of clinical symptoms, functional outcome, and cognitive deficits at follow-up. Methods. About 124 UHR individuals were recruited at baseline. In this, 74 UHR individuals were clinically and cognitively assessed after 12 months, while remission status was available for 81 (25 remission/56 nonremission). Glutamate and GABA levels were assessed at baseline using 3 T proton magnetic resonance spectroscopy. Psychopathology, symptom severity, and remission were assessed with the Comprehensive Assessment of At-Risk Mental States and Clinical Global Impression and functional outcome with the Social and Occupational Functioning Assessment Scale. Cognitive function was estimated with the Cambridge Neuropsychological Test Automated Battery. Results. There were no differences between baseline glutamate and GABA levels in subjects in the nonremission group compared with the remission group, and baseline metabolites could not predict remission status. However, higher baseline levels of GABA in ACC were associated with clinical global improvement (r = −0.34, N = 51, p = 0.01) in an explorative analysis. Conclusions. The variety in findings across studies suggests a probable multifactorial influence on clinical outcome in UHR individuals. Future studies should combine multimodal approaches to attempt prediction of long-term outcome.
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Worthington, Michelle A., Amar Mandavia, and Randall Richardson-Vejlgaard. "Prospective prediction of PTSD diagnosis in a nationally representative sample using machine learning." BMC Psychiatry 20, no. 1 (November 10, 2020). http://dx.doi.org/10.1186/s12888-020-02933-1.
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Abstract Background Recent research has identified a number of pre-traumatic, peri-traumatic and post-traumatic psychological and ecological factors that put an individual at increased risk for developing PTSD following a life-threatening event. While these factors have been found to be associated with PTSD in univariate analyses, the complex interactions of these risk factors and how they contribute to individual trajectories of the illness are not yet well understood. In this study, we examine the impact of prior trauma, psychopathology, sociodemographic characteristics, community and environmental information, on PTSD onset in a nationally representative sample of adults in the United States, using machine learning methods to establish the relative contributions of each variable. Methods Individual risk factors identified in Waves 1 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) were combined with community-level data for the years concurrent to the NESARC Wave 1 (n = 43,093) and 2 (n = 34,653) surveys. Machine learning feature selection and classification analyses were used at the national level to create models using individual- and community-level variables that would best predict the new onset of PTSD at Wave 2. Results Our classification algorithms yielded 89.7 to 95.6% accuracy for predicting new onset of PTSD at Wave 2. A prior diagnosis of DSM-IV-TR Borderline Personality Disorder, Major Depressive Disorder or Anxiety Disorder conferred the greatest relative influence in new diagnosis of PTSD. Distal risk factors such as prior psychiatric diagnosis accounted for significantly greater relative risk than proximal factors (such as adverse event exposure). Conclusions Our findings show that a machine learning classification approach can successfully integrate large numbers of known risk factors for PTSD into stronger models that account for high-dimensional interactions and collinearity between variables. We discuss the implications of these findings as pertaining to the targeted mobilization emergency mental health resources. These findings also inform the creation of a more comprehensive risk assessment profile to the likelihood of developing PTSD following an extremely adverse event.
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Green, L. "The Public Health Implications of Brexit in Wales: A Health Impact Assessment (HIA) approach." European Journal of Public Health 29, Supplement_4 (November 1, 2019). http://dx.doi.org/10.1093/eurpub/ckz185.596.
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Abstract On March 29th 2019, the United Kingdom was due to exit the European Union (EU) in a process known informally as ‘Brexit’. The 2 years before this time (and ongoing) experienced a period of unprecedented political and social upheaval with many unknowns and much uncertainty attached to the outcomes and future impact of withdrawal and transitionary period. Public Health Wales commissioned the Wales Health Impact Assessment (HIA) Support Unit to carry out a HIA of Brexit in Wales to assess the potential impact, extent and nature of ‘Brexit’ on health and wellbeing in Wales which would to inform its planning, future work and support other bodies decision-making, planning and policymaking. A comprehensive HIA was conducted over a 6 month period in 2018/19, steered by a Strategic Advisory Group. Methods included; a literature review; stakeholder workshop; interviews with policy leads, a community health profile, and report with evidence synthesis. Trade agreements, economic impacts, changing relationships with EU agencies, uncertainty and loss of regulatory alignment were key pathways for health impacts to occur. Potential impacts included; food standards/safety; environmental regulations; working conditions; and health and social care. Many impacts will affect the whole population. Vulnerable populations included; children/young people; those at risk of unemployment;Welsh areas receiving significant EU funding. Potential indirect impacts were identified on mental well-being. Brexit has the potential to impact significantly on the determinants of health.The HIA has informed and influenced cross-sector planning and policy in response to the short/long-term implications of Brexit to ensure that health and inequalities are considered at every juncture.This unique work demonstrates continued leadership by Wales in the field of impact assessment and ‘health in policies’ and has been positively received. It has transferable learnings for many nation states and health policy leads. Key messages Brexit is a major policy change with major health impacts. HIA is an informative and influencing process to support planning and future policy making.