ORCID Profile
0000-0002-0401-9791
Current Organisations
Erasmus MC
,
University of Manchester
,
Deakin University
,
Erasmus University Rotterdam
,
University of Melbourne
Does something not look right? The information on this page has been harvested from data sources that may not be up to date. We continue to work with information providers to improve coverage and quality. To report an issue, use the Feedback Form.
Related Links
Publications
Randomized Controlled Trial of Interventions for Young People at Ultra-High Risk of Psychosis: Study Design and Baseline Characteristics
Publisher: SAGE Publications
Date: 2009
DOI: 10.1080/00048670903107625
Abstract: Objective: Intervention during the pre-psychotic period of illness holds the potential of delaying or even preventing the onset of a full-threshold disorder, or at least of reducing the impact of such a disorder if it does develop. The first step in realizing this aim was achieved more than 10 years ago with the development and validation of criteria for the identification of young people at ultra-high risk (UHR) of psychosis. Results of three clinical trials have been published that provide mixed support for the effectiveness of psychological and pharmacological interventions in preventing the onset of psychotic disorder. Method: The present paper describes a fourth study that has now been undertaken in which young people who met UHR criteria were randomized to one of three treatment groups: cognitive therapy plus risperidone (CogTher + Risp: n = 43) cognitive therapy plus placebo (CogTher + Placebo: n = 44) and supportive counselling + placebo (Supp + Placebo n = 28). A fourth group of young people who did not agree to randomization were also followed up (monitoring: n = 78). Baseline characteristics of participants are provided. Results and conclusion: The present study improves on the previous studies because treatment was provided for 12 months and the independent contributions of psychological and pharmacological treatments in preventing transition to psychosis in the UHR cohort and on levels of psychopathology and functioning can be directly compared. Issues associated with recruitment and randomization are discussed.
The Ultra-High Risk Concept-A Review
Publisher: SAGE Publications
Date: 2013
DOI: 10.1177/070674371305800103
Abstract: Attempts to identify people at imminent risk of psychotic disorder have been made during the past 20 years. High-risk criteria have been developed, and despite findings of a recent decline in the rate of onset of psychosis associated with these criteria, people identified still have a significantly greater risk, compared with the general population. Intervention studies in this group indicate that psychological treatments and fish oil appear to be just as effective as antipsychotics. Future research should refine risk factors for psychosis and examine outcomes other than psychosis. Research is also needed into what harms and benefits are associated with making the high-risk criteria into a formal diagnosis.
Early psychosis: Where we've been, where we still have to go
Publisher: Cambridge University Press (CUP)
Date: 06-2007
DOI: 10.1017/S1121189X0000470X
Abstract: Early intervention in psychosis, while not a new concept, has seen great development over the last 15 years. Growth in this time has occurred in a number of areas and has attracted a broad coalition of researchers, consumers, clinicians, carers and policy makers. In this time the concept of early intervention has moved from the fringes to the mainstream of clinical approaches to psychosis in many places, and is doing so in even more. After a decade and a half, this paper reviews some of the key issues that have been addressed and points to areas where further growth and reform is still required. Some issues that have created controversy are examined here including pre-onset intervention and identification, the relationship of duration of untreated psychosis (DUP) to outcome and whether or not early intervention is an effective and economically viable model. Areas that are only now developing or which require further investigation are considered, including the concept of stages of mental illness and concomitant interventions, closing the efficacy-effectiveness gap and an increased focus on functioning as part of the recovery process. Early intervention in psychosis started as a reformist movement, agitating for change from outside the mainstream. Change has occurred and now early intervention is part of the mainstream approach to psychotic illness. In order to continue to develop, while enjoying the benefits of being a mainstream intervention, early intervention must not stray too far from its reformist roots.
Can an I nternet‐based intervention reduce suicidal ideation, depression and hopelessness among secondary school students: results from a pilot study
Publisher: Wiley
Date: 31-03-2014
DOI: 10.1111/EIP.12137
Abstract: Little evidence exists regarding the efficacy of suicide prevention programmes among the youth. This pilot study aimed to test the effects of a specifically designed, eight-module Internet-based programme on suicidal ideation among secondary school students. The study employed a pre-test ost-test design. Outcomes of interest were suicidal ideation, depression and hopelessness. Participants were recruited via the school well-being team, were assessed at baseline and immediately post-intervention. The intervention was delivered weekly at the young persons' school. Twenty-one students completed all eight modules and a post-intervention assessment, and constitute the observed case s le used for the analysis. Overall levels of suicidal ideation, depressive symptoms and hopelessness decreased significantly over the course of the study. This was a small pilot study with no control group. However, significant reductions were seen in suicidal ideation, depressive symptoms and hopelessness, indicating that Internet-based interventions may hold promise when it comes to reducing suicide risk among youth. Further investigation is warranted.
The safety and acceptability of delivering an online intervention to secondary students at risk of suicide: findings from a pilot study
Publisher: Wiley
Date: 31-03-2014
DOI: 10.1111/EIP.12136
Abstract: Suicide-related behaviour is a major problem among adolescents. Yet relatively few studies have tested the efficacy, acceptability and safety of interventions for this population. We developed and pilot tested an online intervention for at-risk school students, which has led to reduced suicidal ideation, hopelessness and depressive symptoms. The aims of this study were to examine the safety and acceptability of the programme, and to determine which components were found to be most helpful and enjoyable. This pilot study employed a pre-test ost-test design, with an 8-week intervention phase. Participants were assessed immediately before, and immediately after the intervention. Participants were also asked to complete a weekly questionnaire immediately after the intervention, and again 2 days later assessing suicidal ideation and distress. Twenty-one young people completed the intervention. Overall, the intervention did not lead to increases in suicidal ideation or distress. Participants reported enjoying the programme, in particular watching the video diaries and completing the activities, and said they would recommend the programme to a friend. Overall, the cognitive components of the programme were found to be most helpful. Overall, the programme appeared to be a safe and acceptable intervention for at-risk adolescents. This was a small, pilot study so we need to interpret the results with caution. However, the findings are promising and suggest that young people at risk of suicide can safely be included in trials as long as adequate safety procedures are in place. The programme is now being tested in a randomized controlled trial.
Can we predict the onset of first-episode psychosis in a high-risk group?
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 1998
SOCIAL COGNITION IN ULTRA HIGH RISK (PUTATIVELY PRODROMAL) AND FIRST EPISODE PSYCHOSIS COHORTS: PRELIMINARY FINDINGS ON DEGREE OF IMPAIRMENT
Publisher: Elsevier BV
Date: 04-2010
Study protocol for a randomised controlled trial of CBT vs antipsychotics vs both in 14–18-year-olds: Managing Adolescent first episode Psychosis: a feasibility study (MAPS)
Publisher: Springer Science and Business Media LLC
Date: 04-07-2019
Comorbid Depressive and Anxiety Disorders in 509 Individuals With an At-Risk Mental State: Impact on Psychopathology and Transition to Psychosis
Publisher: Oxford University Press (OUP)
Date: 22-11-2014
Pre-onset risk characteristics for mania among young people at clinical high risk for psychosis
Publisher: Elsevier BV
Date: 02-2018
DOI: 10.1016/J.SCHRES.2017.04.036
Abstract: Psychosis and mania share conceptual, genetic and clinical features, which suggest the possibility that they have common antecedents. Participants identified to be at-risk for psychosis might also be at-risk for mania. We aimed to identify the rate and predictors of transition to mania in a cohort of youth with clinical or familial risk for psychosis. Among a cohort of 416 young people with an at-risk mental state for psychosis defined using the Ultra-High-Risk (UHR) criteria, 74.7% were followed up between 5 and 13years from their baseline assessment. We undertook a matched case-control examination of those who developed mania over the follow-up period compared to those who did not develop mania or psychosis. Transition to mania was determined using either a structured clinical interview, or diagnoses from a state-wide public mental health contact registry. Clinical characteristics and risk factors were examined at baseline using information from structured interviews, clinical file notes, rating scales and unstructured assessments. Eighteen participants developed mania (UHR-Manic transition or UHR-M, 4.3%). In comparison with participants matched on age, gender and baseline-study who developed neither mania nor psychosis, more UHR-M participants had subthreshold manic symptoms or were prescribed antidepressants at baseline. They also had lower global functioning. In addition to the UHR criteria, features such as subthreshold manic symptoms and antidepressant use may help identify at-risk groups that predict the onset of mania in addition to transition to psychosis. Presence of manic symptoms may also indicate syndrome specificity early in the prodromal phase.
The Mitochondrial Protein Import Component, TRANSLOCASE OF THE INNER MEMBRANE17-1, Plays a Role in Defining the Timing of Germination in Arabidopsis
Publisher: Oxford University Press (OUP)
Date: 24-09-2014
Effects of omega-3 polyunsaturated fatty acid supplementation on cognitive functioning in youth at ultra-high risk for psychosis: secondary analysis of the NEURAPRO randomised controlled trial
Publisher: Royal College of Psychiatrists
Date: 09-2022
DOI: 10.1192/BJO.2022.572
Abstract: Cognitive impairments are well-established features of psychotic disorders and are present when in iduals are at ultra-high risk for psychosis. However, few interventions target cognitive functioning in this population. To investigate whether omega-3 polyunsaturated fatty acid ( n −3 PUFA) supplementation improves cognitive functioning among in iduals at ultra-high risk for psychosis. Data ( N = 225) from an international, multi-site, randomised controlled trial (NEURAPRO) were analysed. Participants were given omega-3 supplementation (eicosapentaenoic acid and docosahexaenoic acid) or placebo over 6 months. Cognitive functioning was assessed with the Brief Assessment of Cognition in Schizophrenia (BACS). Mixed two-way analyses of variance were computed to compare the change in cognitive performance between omega-3 supplementation and placebo over 6 months. An additional biomarker analysis explored whether change in erythrocyte n −3 PUFA levels predicted change in cognitive performance. The placebo group showed a modest greater improvement over time than the omega-3 supplementation group for motor speed ( η p 2 = 0.09) and BACS composite score ( η p 2 = 0.21). After repeating the analyses without in iduals who transitioned, motor speed was no longer significant ( η p 2 = 0.02), but the composite score remained significant ( η p 2 = 0.02). Change in erythrocyte n-3 PUFA levels did not predict change in cognitive performance over 6 months. We found no evidence to support the use of omega-3 supplementation to improve cognitive functioning in ultra-high risk in iduals. The biomarker analysis suggests that this finding is unlikely to be attributed to poor adherence or consumption of non-trial n −3 PUFAs.
Non-reduction in hippocampal volume is associated with higher risk of psychosis
Publisher: Elsevier BV
Date: 12-2002
DOI: 10.1016/S0920-9964(01)00392-9
Abstract: Previous research using MRI scans has shown reduced hippoc al volumes in chronic schizophrenia and first-episode psychosis compared to well subjects. There are few MRI volumetric studies of high-risk cohorts and no studies that have compared structural measures between high-risk subjects who later developed a psychotic illness and those who did not. Therefore, the question of whether structural changes to the hippoc i precede the onset of an acute psychotic episode has not been answered. Hippoc al and whole brain volumes of 60 people at ultra high-risk (UHR) of developing a psychotic episode (identified through state and trait criteria) were obtained through MRI scan and compared with subjects with first episode psychosis (FEP: n=32), and no mental illness (n=139). Thirty-three percent (n=20) of the UHR cohort developed a psychotic disorder during the 12-month period following the MRI scan. The UHR group as a whole, like the FEP group, had significantly smaller left and right hippoc al volumes than the normal comparison group. Contrary to our initial hypothesis, the left hippoc al volume of the UHR subjects who developed a psychotic disorder was larger than the UHR-non-psychotic subgroup and the FEP group, but no differences were found between the UHR-psychotic and normal groups. The right hippoc us of the UHR-non-psychotic group was significantly smaller than the Normal group but not different to the FEP group. Furthermore, a larger left hippoc al volume of the UHR cohort at intake was associated with the subsequent development of acute psychosis rather than smaller volumes. These results contradicted the expected outcomes, which had been influenced by the neurodevelopmental model of the development of psychosis and an earlier study comparing hippoc al volumes of first episode, chronic schizophrenia and normal populations. One implication of these results is that a process of dynamic central nervous system change may occur during the onset phase of schizophrenia and related disorders, rather than earlier in life as suggested by the neurodevelopmental model. Alternatively, selection factors associated with the UHR cohort may have created a bias in the results. Replication of these results is required in other high-risk cohorts.
Demographic and clinical characteristics of young people seeking help at youth mental health services: baseline findings of the Transitions Study
Publisher: Wiley
Date: 28-03-2015
DOI: 10.1111/EIP.12133
Abstract: The Transitions Study was designed to establish a cohort of young people (12-25 years) seeking help for mental health problems, in order to longitudinally explore and refine a clinical staging model of the development and progression of mental disorders. This paper presents the baseline demographic and clinical characteristics of the cohort, particularly the nature and severity of psychopathology. All eligible young people attending one of four headspace clinical services were invited to participate, and completed a battery of self-report and interviewer-administered measures of psychopathology and functional impairment at baseline, which will be repeated at the annual follow up. Of 1615 eligible clients, 802 young people (66% women mean age = 18.3 years) consented to participate and completed baseline assessments (participation rate = 50%). The severity of mental health problems varied, with 51% meeting the criteria for probable caseness related to generalized anxiety, 45% presenting with moderate to severe depressive symptoms and over a third experiencing subthreshold psychotic symptomatology. Disordered eating (32%) and problematic tobacco (56%), cannabis (30%) and alcohol (38%) use also affected a significant proportion. Overall, 39% of the cohort were classed as being functionally impaired at baseline. The Transitions Study recruited a heterogeneous cohort at baseline in relation to the nature and severity of mental health problems and levels of functional impairment. The variation in clinical presentations within the cohort, from mild, through moderate to severe levels of psychopathology and impairment, increases the likelihood of the Transitions Study ultimately being able to achieve its aims of empirically testing a clinical staging model for mental disorders.
Is basic self‐disturbance in ultra‐high risk for psychosis (‘prodromal’) patients associated with borderline personality pathology?
Publisher: Wiley
Date: 24-01-2013
DOI: 10.1111/EIP.12011
Abstract: Research in the phenomenological tradition suggests that the schizophrenia spectrum is characterized by disturbance of the 'basic' self, whereas borderline personality disorder involves disturbance of the 'narrative' self. The current study investigated this proposal in an ultra-high risk for psychosis s le. The s le consisted of 42 ultra-high-risk participants with a mean age of 19.22 years. Basic self-disturbance was measured using the Examination of Anomalous Self-Experience. Borderline personality pathology was measured using the borderline personality disorder items from the structured clinical interview for DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) Axis II Personality Questionnaire. No correlation was found between the measures of basic self-disturbance and borderline personality pathology. The finding is consistent with the proposal that different (although not mutually exclusive) types of self-disturbance characterize the schizophrenia spectrum and borderline personality disorder. Further research should further examine the question of basic self-disturbance in patients with established borderline personality disorder.
Anatomic Abnormalities of the Anterior Cingulate Cortex Before Psychosis Onset: An MRI Study of Ultra-High-Risk Individuals
Publisher: Elsevier BV
Date: 11-2008
DOI: 10.1016/J.BIOPSYCH.2008.05.032
Abstract: Abnormalities of the anterior cingulate cortex (ACC) are frequently implicated in the pathophysiology of psychotic disorders, but whether such changes are apparent before psychosis onset remains unclear. In this study, we characterized prepsychotic ACC abnormalities in a s le of in iduals at ultra-high-risk (UHR) for psychosis. Participants underwent baseline magnetic resonance imaging and were followed-up over 12-24 months to ascertain diagnostic outcomes. Baseline ACC morphometry was then compared between UHR in iduals who developed psychosis (UHR-P n = 35), those who did not (UHR-NP n = 35), and healthy control subjects (n = 33). Relative to control subjects, UHR-P in iduals displayed bilateral thinning of a rostral paralimbic ACC region that was negatively correlated with negative symptoms, whereas UHR-NP in iduals displayed a relative thickening of dorsal and rostral limbic areas that was correlated with anxiety ratings. Baseline ACC differences between the two UHR groups predicted time to psychosis onset, independently of symptomatology. Subdiagnostic comparisons revealed that changes in the UHR-P group were driven by in iduals subsequently diagnosed with a schizophrenia spectrum psychosis. These findings indicate that anatomic abnormalities of the ACC precede psychosis onset and that baseline ACC differences distinguish between UHR in iduals who do and do not subsequently develop frank psychosis. They also indicate that prepsychotic changes are relatively specific to in iduals who develop a schizophrenia spectrum disorder, suggesting they may represent a diagnostically specific risk marker.
Ultra‐high risk phase: A missed opportunity for physical health care
Publisher: Wiley
Date: 20-11-2017
DOI: 10.1111/EIP.12493
Adolescents and young adults who are not in employment, education, or training
Publisher: BMJ
Date: 18-09-2013
DOI: 10.1136/BMJ.F5270
Rationale and First Results of Developing At-Risk (Prodromal) Criteria for Bipolar Disorder
Publisher: Bentham Science Publishers Ltd.
Date: 02-2012
DOI: 10.2174/138161212799316226
Abstract: Bipolar affective disorder (BD) is a severe, recurrent and disabling disorder with devastating consequences for in iduals, families and society. Although these hazards and costs provide a compelling rationale for development of early detection and early intervention strategies in BD, the development of at-risk criteria for first episode mania is still in an early stage of development. In this paper we review the literature with respect to the clinical, neuroantomical and neuropsychological data, which support this goal. We also describe our recently developed bipolar at-risk criteria (BAR). This criteria comprises the peak age range of the first onset of bipolar disorder, genetic risk, presenting with sub-threshold mania, cyclothymic features or depressive symptoms. An initial pilot evaluation of the BAR criteria in 22 subjects indicated conversion rates to proxies of first-episode mania of 23% within 265 days on average, and high specificity and sensitivity of the criteria. If prospective studies confirm the validity of the BAR criteria, then the criteria would have the potential to open up new avenues of research for indicated prevention in BD and might therefore offer opportunities to ameliorate the severity of, or even prevent BD.
Transition to first episode psychosis in ultra high risk populations: Does baseline functioning hold the key?
Publisher: Elsevier BV
Date: 2013
DOI: 10.1016/J.SCHRES.2012.10.025
Abstract: Baseline functioning has been found to be a strong predictor of transition to psychosis in ultra high risk populations. However, the time course of functioning may enhance prediction. We investigated whether there were different patterns of functioning over time and whether particular temporal patterns were related to baseline characteristics and psychosis outcome. Functional data was assessed at baseline and after 3 to 6year follow-up in an ultra high risk s le (n=158 92 female, mean age=19.28 (SD=3.33), range=14-29). Using the median score of the GAF and the QLS scale, a 'High' and 'Low' group (comprising of subjects functioning above or below median at both baseline and follow-up) and a 'Deterioration' group and 'Improving' group were created. Chi-square analyses showed that the Low and Deteriorating functioning groups were the most likely to develop first-episode psychosis (FEP). Importantly, UHR in iduals with deteriorating functioning were at higher risk of transition than those whose functioning was low at baseline but improved over time (GAF: X(2)=5.10, df=1, p=.02 QLS: X(2)=9.13, df=1, p=.003). Binary logistic regression analyses showed that a decline in functioning was more strongly associated with FEP (GAF: p=<.0001 QLS: p<.0001) than the level of baseline functioning (GAF: p=.005 QLS: p=.09). The deteriorating group could not be distinguished from the High group in terms of baseline symptomatology. With the addition of the 'low functioning' criterion to the UHR criteria, we may miss out on some true positive cases. Limiting our attention to baseline poor functioning may therefore distort the picture in terms of risk for psychosis.
Psychological treatment in pre- and early psychosis
Publisher: Guilford Publications
Date: 03-2003
DOI: 10.1521/JAAP.31.1.229.21933
Abstract: This article aims to overview a broad range of psychosocial treatments for first-episode psychosis, and for the prodromal phase (or so-called at-risk mental state)--the period preceding the first acute episode (Yung and McGorry, 1996). Firstly, an introduction to the empirically based rationale for early intervention in first-episode psychosis is provided. This is followed by a selective review of in idual psychotherapies for early psychosis, which then proceeds to a discussion of family-based interventions for first-episode families and the role of group programs. Next, the role of psychological interventions within the newly emerging indicated preventive approach (Mrazek and Haggerty, 1994) for at-risk mental state is examined before some illustrative case material is presented. It is concluded that integrated psychosocial interventions for first-episode psychosis and for prodrome are newly emerging, innovative fields that offer some preventive opportunities. These opportunities, combined with some initial outcome data, warrant continuing research and clinical innovation.
Neuroimaging and treatment evidence for clinical staging in psychotic disorders: From the at-risk mental state to chronic schizophrenia | Evidencia de neuroimagen y de tratamiento respecto a los estadios clínicos en los trastornos psicóticos: Del estado mental de riesgo a la esquizofrenia crónica
Publisher: Elsevier BV
Date: 07-2011
Antibodies to Infectious Agents in Individuals at Ultra-High Risk for Psychosis
Publisher: Elsevier BV
Date: 05-2007
DOI: 10.1016/J.BIOPSYCH.2006.09.034
Abstract: While there is evidence that some cases of schizophrenia may be associated with microbial infections, the role of microbial agents has not been investigated in people with emerging psychosis. Participants were 105 help seeking ultra-high risk in iduals. Psychiatric measures included the Brief Psychiatric Rating Scale and the Scale for the Assessment of Negative Symptoms. Serum IgG antibodies against human herpesviruses and Toxoplasma gondii were determined using immunoassay methods. Multiple linear regression with adjustment for age and sex was applied to test associations between serum antibodies and psychiatric measures. Higher levels of serum IgG antibodies against Toxoplasma gondii in Toxoplasma-positive in iduals were significantly associated with more severe positive psychotic symptoms. No significant association was observed between antibody levels and psychiatric measures in in iduals positive for human herpesviruses. In some in iduals infection with Toxoplasma gondii may be an environmental factor contributing to the manifestation of positive psychotic symptoms.
Neuroanatomical abnormalities before and after onset of psychosis: A cross-sectional and longitudinal MRI comparison
Publisher: Elsevier BV
Date: 2003
Validation of the clinical antisaccade task to assess distractibility across three stages of psychosis
Publisher: Elsevier BV
Date: 1998
Evidence that complement and coagulation proteins are mediating the clinical response to omega-3 fatty acids: A mass spectrometry-based investigation in subjects at clinical high-risk for psychosis
Publisher: Springer Science and Business Media LLC
Date: 28-10-2022
DOI: 10.1038/S41398-022-02217-0
Abstract: Preliminary evidence indicates beneficial effects of omega-3 polyunsaturated fatty acids (PUFAs) in early psychosis. The present study investigates the molecular mechanism of omega-3 PUFA-associated therapeutic effects in clinical high-risk (CHR) participants. Plasma s les of 126 CHR psychosis participants at baseline and 6-months follow-up were included. Plasma protein levels were quantified using mass spectrometry and erythrocyte omega-3 PUFA levels were quantified using gas chromatography. We examined the relationship between change in polyunsaturated PUFAs (between baseline and 6-month follow-up) and follow-up plasma proteins. Using mediation analysis, we investigated whether plasma proteins mediated the relationship between change in omega-3 PUFAs and clinical outcomes. A 6-months change in omega-3 PUFAs was associated with 24 plasma proteins at follow-up. Pathway analysis revealed the complement and coagulation pathway as the main biological pathway to be associated with change in omega-3 PUFAs. Moreover, complement and coagulation pathway proteins significantly mediated the relationship between change in omega-3 PUFAs and clinical outcome at follow-up. The inflammatory protein complement C5 and protein S100A9 negatively mediated the relationship between change in omega-3 PUFAs and positive symptom severity, while C5 positively mediated the relationship between change in omega-3 and functional outcome. The relationship between change in omega-3 PUFAs and cognition was positively mediated through coagulation factor V and complement protein C1QB. Our findings provide evidence for a longitudinal association of omega-3 PUFAs with complement and coagulation protein changes in the blood. Further, the results suggest that an increase in omega-3 PUFAs decreases symptom severity and improves cognition in the CHR state through modulating effects of complement and coagulation proteins.
Volumetric Abnormalities Predating the Onset of Schizophrenia and Affective Psychoses: An MRI Study in Subjects at Ultrahigh Risk of Psychosis
Publisher: Oxford University Press (OUP)
Date: 25-04-2012
Cognitive functioning in ultra-high risk for psychosis individuals with and without depression: Secondary analysis of findings from the NEURAPRO randomized clinical trial
Publisher: Elsevier BV
Date: 04-2020
Long-term maintenance and effects of exercise in early psychosis
Publisher: Wiley
Date: 09-2018
DOI: 10.1111/EIP.12365
Relationship Between Polyunsaturated Fatty Acids and Psychopathology in the NEURAPRO Clinical Trial
Publisher: Frontiers Media SA
Date: 06-06-2019
Basic Self-Disturbance Predicts Psychosis Onset in the Ultra High Risk for Psychosis Prodromal Population
Publisher: Oxford University Press (OUP)
Date: 20-02-2012
Pituitary volume in psychosis
Publisher: Royal College of Psychiatrists
Date: 07-2004
DOI: 10.1192/BJP.185.1.5
Abstract: Patients with psychosis have activation of the hypothalamic-pituitary-adrenal (HPA) axis during the acute phase of the psychosis. Whether this has any morphological consequences for the pituitary gland is currently unknown. To examine pituitary volume variation in people at different stages of psychotic disorder. Pituitary volume was measured using 1.5 mm, coronal magnetic resonance images in 24 people with first-episode psychosis, 51 with established schizophrenia and 59 healthy controls. Compared with the control group, the people with first-episode psychosis had pituitary volumes that were 10% larger, whereas those with established schizophrenia had pituitary volumes that were 17% smaller. In both of the groups with psychosis, there was no difference in pituitary volume between those receiving typical antipsychotic drugs and those receiving atypical antipsychotics. The first episode of a psychosis is associated with a larger pituitary volume, which we suggest is due to activation of the HPA axis. The smaller pituitary volume in the group with established schizophrenia could be the consequence of repeated episodes of HPA axis hyperactivity.
Hippocampal pathology in individuals at ultra-high risk for psychosis: A multi-modal magnetic resonance study
Publisher: Elsevier BV
Date: 08-2010
DOI: 10.1016/J.NEUROIMAGE.2010.04.012
Abstract: Although the hippoc us is a key brain region in the pathophysiology of schizophrenia, it is unclear whether structural or biochemical abnormalities predate illness onset. In this study, we used magnetic resonance imaging and spectroscopy data acquired prior to both the onset of psychosis and treatment with antipsychotics to determine this. Sixty-six young people clinically at ultra high-risk of development of psychosis were recruited, 59 of whom did not later develop a psychotic disorder and 7 who had done so after at least 24 months follow-up. These participants were compared with 29 healthy comparison subjects on multiple independent magnetic resonance measures: hippoc al volume, hippoc al T2 relaxation time, and medial temporal lobe metabolite concentrations (including N-acetylaspartate). We found similar reductions in left hippoc al volume in the at-risk group compared to comparison subjects regardless of later transition status on the right this only reached significance for the at-risk group who did not transition to psychosis. T2 relaxation time in the left hippoc al head was significantly elevated in the later-psychotic group, and this elevation positively correlated with total positive symptoms in the UHR group as a whole. Medial temporal lobe metabolite concentrations did not differ. These findings suggest that there are subtle pathological changes in the hippoc us prior to the development of psychosis, but that they are limited to the left hippoc al head. However, standard measures of neuroanatomical disturbance do not appear to be predictive of later transition, and instead are likely to be non-specific and common in cases that later develop a non-psychotic disorder.
Borderline personality pathology in young people at ultra high risk of developing a psychotic disorder
Publisher: Wiley
Date: 23-03-2017
DOI: 10.1111/EIP.12236
Abstract: The association between borderline personality disorder and the ultra high risk (UHR) for psychosis state is unclear. The following study aimed to investigate the type of attenuated psychotic symptoms and prevalence of borderline personality pathology in a s le of UHR young people. Additionally, the study aimed to explore whether borderline personality pathology influenced the transition rate to psychosis. Medical records from Orygen Youth Health between 2007 and 2009 were examined. There were 180 patients who met UHR criteria and were included for analysis. Most patients were females (62.8%) and age ranged from 15 to 24 years. A quarter (25.2%) of UHR patients endorsed items consistent with borderline personality pathology. UHR patients with borderline personality pathology experienced a range of attenuated psychotic symptoms and could not be statistically differentiated from UHR patients with less significant or without borderline personality pathology. Borderline personality pathology did not increase or decrease the risk of developing a psychotic disorder. The absence of depression was the only predictor of psychosis. Many UHR patients present with concurrent borderline personality features. The psychotic experiences reported by UHR patients with borderline personality features were not limited to paranoid ideation, supporting the idea that borderline personality disorder may include a wider range of psychotic symptoms than previously thought. It is further possible that the psychotic symptoms experienced in this group could also be indicative of an emerging psychotic disorder.
Distinguishing between anxiety and depression using the Mood and Anxiety Symptoms Questionnaire (MASQ)
Publisher: Wiley
Date: 06-2007
WC1E BASIC SYMPTOMS IN THE UHR POPULATION AT THE PACE CLINIC
Publisher: Elsevier BV
Date: 10-2006
Amygdala volume status might reflect dominant mode of emotional information processing - In reply
Publisher: American Medical Association (AMA)
Date: 02-2007
A randomised, double-blind, placebo-controlled trial of minocycline and/or omega-3 fatty acids added to treatment as usual for at-risk mental states (NAYAB): study protocol
Publisher: Springer Science and Business Media LLC
Date: 09-11-2017
Development and Validation of a New Measure of Everyday Adolescent Functioning: The Multidimensional Adolescent Functioning Scale
Publisher: Elsevier BV
Date: 02-2013
DOI: 10.1016/J.JADOHEALTH.2012.06.021
Abstract: Everyday functioning is an important outcome for studies of the developmental psychopathology of adolescence. An unbiased, well-validated, and easy-to-use instrument to specifically assess normal adolescent functioning is not yet available. The current study aimed to introduce and validate the Multidimensional Adolescent Functioning Scale (MAFS). The MAFS was developed by clinical consensus, resulting in a 23-item self-report questionnaire with three distinct subscales: general functioning, family-related functioning, and peer-related functioning. MAFS data were collected in a general population s le (N = 842 mean age = 15.0 years [standard deviation = .4]) at baseline and again at 1- and 3-year follow-up. Psychometric analyses included confirmatory factor analysis, calculations of internal consistency, scale correlations, and correlations with the abridged General Health Questionnaire. Confirmatory factor analysis showed that the hypothesized 3-factor structure fits well to the MAFS data. All scales showed adequate internal consistency (greatest lower bound: .75-.91) and sufficient discriminative ability (scale intercorrelations: ρ = .15-.52). Of the scales, general functioning was most strongly correlated with the General Health Questionnaire, whereas family- and peer-related functioning showed weaker correlations with this general measure. The results were stable across repeated measurements and gender groups. The MAFS is an easy-to-use instrument with good psychometric characteristics, which could be suitable for a broad range of future research applications, especially when a multidimensional and unbiased indication of normal adolescent functioning is required.
Validation of prodromal criteria to detect individuals at ultra high risk of psychosis: 2 year follow-up
Publisher: Elsevier BV
Date: 10-2008
DOI: 10.1016/J.SCHRES.2008.07.012
Abstract: Identification of in iduals "prodromal" for schizophrenia and other psychotic disorders relies on criteria that predict onset within a brief period. Previous trials and biological research have been predicated on the view that certain "ultra high risk" (UHR) criteria detect "the prodrome", but there is a need to test the validity of these criteria. To assess the predictive validity of the UHR criteria in a clinical population. The presence of UHR criteria was determined in 292 help-seeking in iduals. At 2 year follow-up the number of new cases of psychotic disorder was assessed. The criteria significantly predicted onset of psychotic disorder within 2 years. The transition rate of 16% was much lower than in initial cohorts (over 40%). The predictive validity of UHR criteria depends on the s le to which they are applied. Although young help-seekers meeting these criteria are at greater risk of psychotic disorder than those who do not meet them, caution is needed in their management, since a high transition rate can no longer be assumed.
Management of early psychosis in a generic adult mental health service
Publisher: SAGE Publications
Date: 08-2003
DOI: 10.1046/J.1440-1614.2003.01196.X
Abstract: Objective: To evaluate current practice at a generic adult mental health service, St Vincent's Mental Health Service (SVMHS) in relation to management of patients with early psychosis. A further aim was to compare treatment of early psychosis patients within this generic service with management of a similar group in a specialized early psychosis service. Method: A case file audit of all patients identified as having early psychosis (within the first 2 years of treatment) was undertaken using a standardized audit tool. Variables including proportion of early psychosis admitted as inpatients to the psychiatric unit, average length of stay (LOS), use of seclusion, involvement of police in admission process, mean neuroleptic dose and estimated duration of untreated psychosis (DUP) were studied. Results of this audit were then compared with published evaluative data from the Early Psychosis Prevention and Intervention Centre (EPPIC), a service specifically catering for young people with early psychosis (within the first 18 months of treatment). Results: Data were collected on 62 of 68 patients identified as having early psychosis. Within the generic service, mean DUP was found to be about 15 months, a high proportion (81%) of patients were admitted and secluded (22% of those admitted), average length of stay was 46.5 days and use of police in the admission process was also high (40% of those admitted). This compares unfavourably with the EPPIC data of mean DUP of just over 6 months, 64.1% of patients admitted, 10.3% secluded, average LOS 12.9 days, and police involved in 3.8% of admissions. Conclusions: We believe that practice at SVMHS in relation to early psychosis patients is fairly typical of management of these patients within generic services as a whole. These services tend to focus on the needs of the majority of their patients, those with chronic schizophrenia, rather than the small group of patients with early psychosis (who make up about 8% of current case-load at SVMHS). Failure to assertively assess and follow-up young people with early psychosis may contribute to long DUPs, which may in turn result in patients being more disturbed at time of initial treatment, thus requiring inpatient treatment and longer length of stay. Additionally, staff at generic services may not feel confident in managing early psychosis patients and may be unaware of the special needs of this patient group. These preliminary data suggest that generic services are not optimal for treatment of early psychosis patients and that treatment of early psychosis within them is not cost-effective
Study protocol: the development of a randomised controlled trial testing a postcard intervention designed to reduce suicide risk among young help-seekers
Publisher: Springer Science and Business Media LLC
Date: 23-09-2009
Does cognitive behavioural therapy have a role in improving problem solving and coping in adolescents with suicidal ideation?
Publisher: Cambridge University Press (CUP)
Date: 07-08-2014
DOI: 10.1017/S1754470X14000129
Abstract: Problem-solving and coping skills deficits have been shown in adolescents who experience suicide-related behaviours, including suicidal ideation. Little evidence exists about effective interventions for this population. We undertook a pilot study of an Internet-based CBT programme that included problem-solving skills training to investigate its impact on skills deficits. The study employed a pre-test ost-test design. Outcomes of interest were negative problem orientation, emotion- and task-focused coping, and adolescents’ perception of helpfulness of the intervention. Participants, recruited via the school wellbeing team, were assessed at baseline, at weekly intervention sessions and immediately post-intervention. Twenty-one adolescents completed the intervention. Over the course of the intervention, negative problem-solving orientation improved and students relied less on emotion-focused coping strategies. Because there was no control group, we cannot be certain that the changes seen between baseline and post-intervention can be attributed to the intervention. Adolescents rated the problem-solving and cognitive restructuring modules as particularly helpful. Interventions that include enhancement of problem-solving skills, as well as cognitive restructuring to address adolescents’ appraisal of problems and their ability to solve them appear promising for adolescents with suicidal ideation. Further investigation is warranted.
0553 ASSESSING THOSE AT HIGH RISK OF PSYCHOTIC DISORDER –AN EXPERIENTIAL WORKSHOP USING THE COMPREHENSIVE ASSESSMENT OF AT RISK MENTAL STATES (CAARMS)
Publisher: Elsevier BV
Date: 10-2006
Distress in relation to attenuated psychotic symptoms in the ultra-high-risk population is not associated with increased risk of psychotic disorder
Publisher: Wiley
Date: 15-03-2016
DOI: 10.1111/EIP.12233
Abstract: The 'ultra-high-risk' criteria identify a clinical population at substantially increased risk for progressing to schizophrenia and other psychotic disorders. Although a number of clinical variables predictive of transition to psychotic disorder have been identified within this population, the predictive value of the level of distress associated with attenuated psychotic symptoms has not yet been examined. This was the aim of the present study. The level of distress (0-100) associated with attenuated psychotic symptoms was recorded for 70 ultra-high-risk (UHR) patients using the Comprehensive Assessment of At-Risk Mental State (CAARMS). Transition to psychosis was assessed over a 16-month follow-up period. Of the 70 UHR patients, 15 transitioned to psychosis (21.4%). Of the four CAARMS subscales measuring attenuated positive symptoms, Perceptual Abnormalities was rated as the most distressing. There were no differences in CAARMS scales rated as the most distressing between those who transitioned to psychosis and those who did not. There was also no association between higher levels of distress associated with attenuated psychotic symptoms and transition to psychosis. Although the findings require replication, they indicate that the degree of distress associated with attenuated psychotic symptoms should not be used as a criterion for enriching UHR s les for risk of frank psychotic disorder.
Neuroimaging and Treatment Evidence for Clinical Staging in Psychotic Disorders: From the At-Risk Mental State to Chronic Schizophrenia
Publisher: Elsevier BV
Date: 10-2011
DOI: 10.1016/J.BIOPSYCH.2011.05.034
Abstract: A new approach to understanding severe mental disorders such as schizophrenia is to adopt a clinical staging model. Such a model defines the extent of the illness such that earlier and milder phenomena are distinguished from later, more impairing features. Specifically, a clinical staging model makes three key predictions. First, pathologic measures should be more abnormal in more severe stages. Second, patients who progress between the stages should show change in these same pathologic measures. Finally, treatment should be more effective in the earlier stages, as well as more benign. In this article, we review the evidence for these three predictions from studies of psychotic disorders, with a focus on neuroimaging data. For all three, the balance of evidence supports the predictions of the staging model. However, there are a number of alternative explanations for these findings, including the effects of medication and symptom heterogeneity.
The effectiveness of simple psychological and exercise interventions for high prevalence mental health problems in young people: A factorial randomised controlled trial
Publisher: Springer Science and Business Media LLC
Date: 13-03-2011
The initial manic prodrome: Implications for early detection and intervention
Publisher: Elsevier BV
Date: 03-2003
Declining transition rates to psychosis: The contribution of potential changes in referral pathways to an ultra-high-risk service
Publisher: Wiley
Date: 14-11-2015
DOI: 10.1111/EIP.12105
Abstract: On the basis of applying 'ultra-high-risk' (UHR) criteria, initially high rates of transition to psychosis were reported. However, a decline in transition to psychosis has been observed in recent years. The current descriptive paper aims to investigate if this drop in transition rate may be due to potential changes in patterns of referral to a large UHR clinic. One hundred fifty young people who were referred to the Personal Assessment and Crisis Evaluation (PACE) Clinic in Melbourne, Australia, between August 2000 and July 2004 were included. Their referral pathways were assessed using a semistructured interview. Results were compared with a similar study of a cohort referred to the same clinic between 1995 and 1996. The mean number of contacts prior to referral to the PACE Clinic was 1.93 (standard deviation (SD) = 1.15), and the average time between symptom onset and referral to PACE was 46.5 weeks (SD = 57.4). In comparison with the earlier cohort (mean = 2.36 SD = 1.32), our results indicate a lower number of contacts (Cohen's d = 0.35, r = 0.17). Furthermore, participants in the current study were referred twice as fast to the PACE Clinic. Increasing awareness of UHR symptoms among professionals and in the general population seems to have resulted in faster referral of young people to specialized mental health services. The global drop in transition rate might be due to a change in referral pathways to UHR services.
Towards a youth mental health paradigm: a perspective and roadmap
Publisher: Springer Science and Business Media LLC
Date: 14-08-2023
DOI: 10.1038/S41380-023-02202-Z
Abstract: Most mental disorders have a typical onset between 12 and 25 years of age, highlighting the importance of this period for the pathogenesis, diagnosis, and treatment of mental ill-health. This perspective addresses interactions between risk and protective factors and brain development as key pillars accounting for the emergence of psychopathology in youth. Moreover, we propose that novel approaches towards early diagnosis and interventions are required that reflect the evolution of emerging psychopathology, the importance of novel service models, and knowledge exchange between science and practitioners. Taken together, we propose a transformative early intervention paradigm for research and clinical care that could significantly enhance mental health in young people and initiate a shift towards the prevention of severe mental disorders.
The site of hippocampal volume reduction differs between first-episode and chronic schizophrenia
Publisher: Elsevier BV
Date: 1998
Road to full recovery: Longitudinal relationship between symptomatic remission and psychosocial recovery in first-episode psychosis over 7.5 years
Publisher: Cambridge University Press (CUP)
Date: 19-08-2012
DOI: 10.1017/S0033291711001504
Abstract: In recent years there has been increasing interest in functional recovery in the early phase of schizophrenia. Concurrently, new remission criteria have been proposed and several studies have examined their clinical relevance for prediction of functional outcome in first-episode psychosis (FEP). However, the longitudinal interrelationship between full functional recovery (FFR) and symptom remission has not yet been investigated. This study sought to: (1) examine the relationships between FFR and symptom remission in FEP over 7.5 years (2) test two different models of the interaction between both variables. Altogether, 209 FEP patients treated at a specialized early psychosis service were assessed at baseline, 8 months, 14 months and 7.5 years to determine their remission of positive and negative symptoms and functional recovery. Multivariate logistic regression and path analysis were employed to test the hypothesized relationships between symptom remission and FFR. Remission of both positive and negative symptoms at 8-month follow-up predicted functional recovery at 14-month follow-up, but had limited value for the prediction of FFR at 7.5 years. Functional recovery at 14-month follow-up significantly predicted both FFR and remission of negative symptoms at 7.5 years, irrespective of whether remission criteria were simultaneously met. The association remained significant after controlling for baseline prognostic indicators. These findings provided support for the hypothesis that early functional and vocational recovery plays a pivotal role in preventing the development of chronic negative symptoms and disability. This underlines the need for interventions that specifically address early psychosocial recovery.
Managing deliberate self-harm in young people: An evaluation of a training program developed for school welfare staff using a longitudinal research design
Publisher: Springer Science and Business Media LLC
Date: 15-09-2008
The Singapore flagship programme in translational and clinical research in psychosis
Publisher: Wiley
Date: 27-10-2011
DOI: 10.1111/J.1751-7893.2011.00304.X
Abstract: This paper describes the rationale, aims and development of the Singapore Translational and Clinical Research in Psychosis, which is a 5-year programme. The authors provide a selective review of the pertinent findings from the clinical, neuropsychological, genetics and neuroimaging studies on high-risk population and how they were factored in the hypotheses and design of this translational clinical research programme. This programme, which draws upon the previous work of various groups and the experience of the investigators of this consortium, comprises three interlinked studies. The first is a genome-wide association and copy number variation analysis using the diagnostic phenotype of schizophrenia and cognitive phenotypes, and a joint genome-wide analysis performed by combining our data with other datasets to increase the power to detect genetic risk factors. The second is a prospective study of a large group of in iduals who are assessed to be at ultra-high risk of psychosis, and the third is a randomized controlled trial to improve neurocognition in patients with schizophrenia. The convergence of various factors including the unique structured characteristics of the Singaporean society, the presence of political will with availability of funding and the established research infrastructure make it possible to accrue the s le size for adequate power to elucidate biomarkers of disease risk and resilience.
Morphology of the anterior cingulate cortex in young men at ultra-high risk of developing a psychotic illness
Publisher: Royal College of Psychiatrists
Date: 06-2003
Abstract: The anterior cingulate cortex (ACC) is consistently implicated in the pathophysiology of schizophrenia, and our own work has identified morphological anomalies in the ACC of people with this disorder. To examine whether ACC morphological anomalies are present in a group at ultra-high risk of psychosis and whether such anomalies can be used to predict the subsequent development of a psychotic illness. Magnetic resonance imaging of 75 healthy volunteers and 63 people at ultra-high risk of developing a psychotic disorder (all right-handed males) was used to examine ACC sulcal and gyral features. Compared with the controls, significantly fewer people in the ultra-high risk group had a well-developed left paracingulate sulcus and significantly more had an interrupted left cingulate sulcus. There was no difference between those who did ( n =21) and did not ( n =42) subsequently develop a psychotic illness. Although ACC anomalies are present in young people considered to be at ultra-high risk of psychosis, they do not identify in iduals who subsequently make the transition to psychosis.
A factor analytic investigation of the Tripartite model of affect in a clinical sample of young Australians
Publisher: Springer Science and Business Media LLC
Date: 18-09-2008
Abstract: The Mood and Anxiety Symptom Questionnaire (MASQ) was designed to specifically measure the Tripartite model of affect and is proposed to offer a delineation between the core components of anxiety and depression. Factor analytic data from adult clinical s les has shown mixed results however no studies employing confirmatory factor analysis (CFA) have supported the predicted structure of distinct Depression, Anxiety and General Distress factors. The Tripartite model has not been validated in a clinical s le of older adolescents and young adults. The aim of the present study was to examine the validity of the Tripartite model using scale-level data from the MASQ and correlational and confirmatory factor analysis techniques. 137 young people (M = 17.78, SD = 2.63) referred to a specialist mental health service for adolescents and young adults completed the MASQ and diagnostic interview. All MASQ scales were highly inter-correlated, with the lowest correlation between the depression- and anxiety-specific scales (r = .59). This pattern of correlations was observed for all participants rating for an Axis-I disorder but not for participants without a current disorder (r = .18). Confirmatory factor analyses were conducted to evaluate the model fit of a number of solutions. The predicted Tripartite structure was not supported. A 2-factor model demonstrated superior model fit and parsimony compared to 1- or 3-factor models. These broad factors represented Depression and Anxiety and were highly correlated (r = .88). The present data lend support to the notion that the Tripartite model does not adequately explain the relationship between anxiety and depression in all clinical populations. Indeed, in the present study this model was found to be inappropriate for a help-seeking community s le of older adolescents and young adults.
A Membrane-Bound NAC Transcription Factor, ANAC017, Mediates Mitochondrial Retrograde Signaling in Arabidopsis
Publisher: Oxford University Press (OUP)
Date: 09-2013
Abstract: Plants require daily coordinated regulation of energy metabolism for optimal growth and survival and therefore need to integrate cellular responses with both mitochondrial and plastid retrograde signaling. Using a forward genetic screen to characterize regulators of alternative oxidase1a (rao) mutants, we identified RAO2/Arabidopsis NAC domain-containing protein17 (ANAC017) as a direct positive regulator of AOX1a. RAO2/ANAC017 is targeted to connections and junctions in the endoplasmic reticulum (ER) and F-actin via a C-terminal transmembrane (TM) domain. A consensus rhomboid protease cleavage site is present in ANAC017 just prior to the predicted TM domain. Furthermore, addition of the rhomboid protease inhibitor N-p-Tosyl-l-Phe chloromethyl abolishes the induction of AOX1a upon antimycin A treatment. Simultaneous fluorescent tagging of ANAC017 with N-terminal red fluorescent protein (RFP) and C-terminal green fluorescent protein (GFP) revealed that the N-terminal RFP domain migrated into the nucleus, while the C-terminal GFP tag remained in the ER. Genome-wide analysis of the transcriptional network regulated by RAO2/ANAC017 under stress treatment revealed that RAO2/ANAC017 function was necessary for & % of the changes observed as a primary response to cytosolic hydrogen peroxide (H2O2), but only ∼33% of transcriptional changes observed in response to antimycin A treatment. Plants with mutated rao2/anac017 were more stress sensitive, whereas a gain-of-function mutation resulted in plants that had lower cellular levels of H2O2 under untreated conditions.
Cognitive decline following psychosis onset: Data from the PACE clinic
Publisher: Royal College of Psychiatrists
Date: 12-2007
Abstract: The origin of cognitive impairments in psychotic disorders is still unclear. Although some deficits are apparent prior to the onset of frank illness, it is unknown if they progress To investigate whether cognitive function declined over the transition to psychosis in a group of ultra-high risk in iduals Participants consisted of two groups: controls ( n = 17) and in iduals at ultra-high risk for development of psychosis ( n = 16). Seven of the latter group later developed psychosis. Neuropsychological testing was conducted at baseline and again after at least a 12-month interval Both the Visual Reproduction sub-test of the Wechsler Memory Scale-Revised and Trail-Making Test B showed a decline over the follow-up period that was specific to the group who became psychotic. In addition, both high-risk groups showed a decline in digit span performance. No other task showed significant change over time These preliminary data suggest that as psychosis develops there may be a specific decline in visual memory and attentional set-shifting, reflecting impairments in efficient organisation of visual stimuli. This may be caused by either the illness itself or treatment with antipsychotic medication
International clinical practice guidelines for early psychosis
Publisher: Royal College of Psychiatrists
Date: 08-2005
Abstract: These international clinical practice guidelines were developed with detailed input from 29 invited international consultants, who provided content as well as detailed feedback on draft versions. The final draft of the guidelines was ratified by the Executive of the International Early Psychosis Association and presented and formally endorsed at the Third International Conference on Early Psychosis held in Copenhagen, September 2002. They have been revised slightly to include medications that were not available in 2002, although a fully comprehensive process of update has not yet been conducted. The final version is published in this Supplement with the aim of encouraging further discussion as well as providing practical guidance to clinicians and researchers. A second edition is planned for publication in 2008.
Can we detect psychotic-like experiences in the general population?
Publisher: Bentham Science Publishers Ltd.
Date: 02-2012
DOI: 10.2174/138161212799316136
Abstract: The continuum model of psychosis posits that psychotic symptoms are distributed throughout the population, with diagnosable clinical disorder existing at a certain point along this continuum. The total continuum is made up mainly of non-clinical cases with clinical cases of psychosis representing only a small proportion of the total extended psychosis phenotype. This paper is a narrative review of studies of psychotic experiences in the general population. The evidence indicates reasonably high prevalence rates of psychotic experiences in the general population, substantially higher than the prevalence of psychotic disorders, and that they are associated with increased risk of future onset of diagnosable disorder, particularly when the experiences are persistent. Psychotic experiences in the general population share an extensive range of risk factors with schizophrenia and therefore provide a useful phenotype in which to study the aetiology of clinical psychosis. Some types of psychotic experiences, such as paranoid ideas, bizarre thinking and perceptual abnormalities, may indicate a greater level of risk for psychotic disorder than other psychotic experiences, such as magical thinking. There is a need for research that further explores the interplay between psychotic experiences and other risk factors (including psychological, environmental, neurocognitive and genetic factors) in the evolution of psychotic disorder, the types of psychotic experiences that are most associated with risk for clinical disorder, the specificity of risk associated with psychotic experiences, and the possible adaptive advantages of these experiences.
Whither the Attenuated Psychosis Syndrome?
Publisher: Oxford University Press (OUP)
Date: 11-2012
The Lancet Psychiatry Commission: a blueprint for protecting physical health in people with mental illness
Publisher: Elsevier BV
Date: 08-2019
Diagnostic markers for schizophrenia: do we actually know what we're looking for?
Publisher: Wiley
Date: 02-2011
Testing the Ultra High Risk (prodromal) criteria for the prediction of psychosis in a clinical sample of young people
Publisher: Elsevier BV
Date: 05-2006
DOI: 10.1016/J.SCHRES.2006.03.014
Abstract: Criteria for identifying in iduals at imminent risk for onset of a psychotic disorder, that is "prodromal" for psychosis, have recently been described. The current study set out to test the predictive validity of these criteria in a s le of help-seeking young people aged 15-24 years who were referred to, but not necessarily treated at, a psychiatric service. Ultra High Risk (UHR) status was determined at baseline and psychosis status was assessed at 6 month follow up. Baseline psychosocial functioning was also assessed as a possible predictor of psychosis. In the s le of 292 in iduals, 119 (40.7%) met UHR criteria. Of these UHR+ people, 12 became psychotic within 6 months and 107 did not. Only one person not meeting UHR criteria developed psychosis in the follow up period. Sensitivity, specificity, positive predictive value and negative predictive value of UHR+ status for prediction of psychosis were, respectively, 0.923 (95% CI 0.621, 1), 0.616 (95% CI 0.556, 0.673), 0.101 (95% CI 0.056, 0.173) and 0.994 (95% CI 0.963, 1). UHR+ in iduals were significantly more likely to become psychotic than UHR- in iduals (Odds Ratio 19.3, 95% CI 2.5, 150.5). Low functioning at baseline was associated with psychosis onset in the whole s le and in the UHR group. The transition to psychosis rate was much lower than in previous s les. This may be a due to the s le being a more general one, not identified as possibly "prodromal". Other potential causes of this reduction in transition are also explored.
The relationship between coping and subclinical psychotic experiences in adolescents from the general population – a longitudinal study
Publisher: Cambridge University Press (CUP)
Date: 28-04-2011
DOI: 10.1017/S0033291711000560
Abstract: Subclinical psychotic experiences during adolescence may represent liability for developing psychotic disorder. Both coping style and the degree of persistence of psychotic experiences may play a role in the progression to clinical psychotic disorder, but little is known about the causal relationship between the two. Path modelling was used to examine longitudinal relationships between subclinical positive psychotic experiences and three styles of coping (task-, emotion- and avoidance-oriented) in an adolescent general population s le ( n =813) assessed three times in 3 years. Distinct developmental trajectories of psychotic experiences, identified with growth mixture modelling, were compared on the use of these coping styles. Over time, emotion-oriented coping in general was bi-directionally related to psychotic experiences. No meaningful results were found for task- or avoidance-oriented coping. Females reported using a wider range of coping styles than males, but the paths between coping and psychotic experiences did not differ by gender. Persistence of psychotic experiences was associated with a greater use of emotion-oriented coping, whereas a decrease in experiences over time was associated with an increased use of task-orientated coping. Emotion-oriented coping is the most important coping style in relation to psychotic experiences, as it may contribute to a ‘vicious cycle’ and is associated with persistence of experiences. In addition, more task-oriented coping may result in a decrease in psychotic experiences. Results suggest that opportunities for intervention may already be present at the level of subclinical psychosis.
Caudate nucleus volume in individuals at ultra-high risk of psychosis: A cross-sectional magnetic resonance imaging study
Publisher: Elsevier BV
Date: 06-2010
DOI: 10.1016/J.PSCYCHRESNS.2010.02.006
Abstract: The aim of the present study was to investigate whether volumetric abnormalities of the caudate nuclei predate the onset of psychotic illness. Caudate nuclei volume (CNVs), excluding the tail, were measured using region-of-interest (ROI) tracing of magnetic resonance imaging (MRI) scans acquired on a 1.5T scanner. Subjects included 39 in iduals deemed at ultra-high risk of psychosis who converted to psychosis (UHR-P) after initial MRI scanning 39 matched in iduals at ultra-high risk who did not convert to psychosis (UHR-NP) and 39 matched healthy controls. All subjects were neuroleptic-naïve. After adjusting CNVs for intracranial volume (ICV), univariate analyses of variance and repeated measures analyses of variance were undertaken to examine the relationship of CNVs to psychosis transition and to family history of psychosis. Pearson's correlations were used to investigate the relationship of psychopathological scores to CNVs. CNVs did not differ significantly between UHR in iduals and healthy controls, and there was no significant difference between converters and non-converters to psychosis. In the UHR group, presence of family history of psychosis was not related to CNVs. There was no correlation between CNVs and either positive or negative symptoms of schizophrenia. Significant associations were found between larger CNV and increased errors on a spatial working memory task but better verbal fluency performance. These data suggest that the caudate is macroscopically normal prior to illness onset, while the relationship to tasks of executive function may implicate the caudate together with its connections to prefrontal regions. Future research should examine changes longitudinally together with analysis of shape to assess subregions of the caudate that connect with prefrontal cortex.
Follow-up factor structure of schizotypy and its clinical associations in a help-seeking sample meeting ultra-high risk for psychosis criteria at baseline
Publisher: Elsevier BV
Date: 02-2013
DOI: 10.1016/J.COMPPSYCH.2012.06.011
Abstract: Schizotypy is a multidimensional construct indexing psychometric risk for schizophrenia. This study investigated the factor structure and clinical associations of the Oxford-Liverpool Inventory of Feelings and Experiences (O-LIFE) short scales, assessed at follow-up in an originally help-seeking s le identified as ultra-high risk for psychosis. Participants were 228 help-seeking in iduals identified as ultra-high risk for psychosis between 2 and 14 years previously (mean, 7.09 SD, 3.17 median, 6.41). The 43-item O-LIFE short scales (Unusual Experiences, Introvertive Anhedonia, Cognitive Disorganization, Impulsive Nonconformity) and indices of depression, anxiety, positive and negative psychotic symptoms, functioning, and quality of life were administered at follow-up. Structural equation modeling was used. Impulsive Nonconformity was shown to be an unstable factor and was excluded. A 3-factor model of Unusual Experiences, Cognitive Disorganization, and Introvertive Anhedonia was found to be the best description of the data, compared with a 1-factor model. Unusual Experiences factor was associated with positive psychotic symptoms Cognitive Disorganization was associated with depression and anxiety and Introvertive Anhedonia was associated with positive and negative psychotic symptoms, quality of life, and functioning. The Impulsive Nonconformity factor of the O-LIFE short scales should be interpreted with caution. A well-fitting 3-factor model provides support for a dimensional structure in schizotypy that is similar to that of schizophrenia. Separate dimensions were differentially associated with psychopathology, functioning, and quality of life. The interpersonal dimension of schizotypy was the only dimension associated with poorer functioning and quality of life and may be a sensitive indicator of need for care.
Clinical utility of the Mood and Anxiety Symptom Questionnaire (MASQ) in a sample of young help-seekers
Publisher: Springer Science and Business Media LLC
Date: 17-09-2007
Abstract: The overlap between Depression and Anxiety has led some researchers to conclude that they are manifestations of a broad, non-specific neurotic disorder. However, others believe that they can be distinguished despite sharing symptoms of general distress. The Tripartite Model of Affect proposes an anxiety-specific, a depression-specific and a shared symptoms factor. Watson and Clark developed the Mood and Anxiety Symptom Questionnaire (MASQ) to specifically measure these Tripartite constructs. Early research showed that the MASQ distinguished between dimensions of Depression and Anxiety in non-clinical s les. However, two recent studies have cautioned that the MASQ may show limited validity in clinical populations. The present study investigated the clinical utility of the MASQ in a clinical s le of adolescents and young adults. A total of 204 Young people consecutively referred to a specialist public mental health service in Melbourne, Australia were approached and 150 consented to participate. From this, 136 participants completed both a diagnostic interview and the MASQ. The majority of the s le rated for an Axis-I disorder, with Mood and Anxiety disorders most prevalent. The disorder-specific scales of the MASQ significantly discriminated Anxiety (61.0%) and Mood Disorders (72.8%), however, the predictive accuracy for presence of Anxiety Disorders was very low (29.8%). From ROC analyses, a proposed cut-off of 76 was proposed for the depression scale to indicate 'caseness' for Mood Disorders. The resulting sensitivity/specificity was superior to that of the CES-D. It was concluded that the depression-specific scale of the MASQ showed good clinical utility, but that the anxiety-specific scale showed poor discriminant validity.
History of trauma and the association with baseline symptoms in an Ultra-High Risk for psychosis cohort
Publisher: Elsevier BV
Date: 11-2013
DOI: 10.1016/J.PSYCHRES.2013.06.007
Abstract: Few studies have addressed the correlates of trauma in young people at Ultra-High Risk (UHR) of developing a psychotic disorder. We aimed to examine baseline differences in intensity, form and content of attenuated positive psychotic symptoms, other clinical symptomatology and comorbidity between UHR patients with and without a history of trauma. In a s le of 127 UHR in iduals (53 male, 74 female mean age 18.2 years, range 14-26) we assessed trauma history and baseline symptomatology using an audit tool developed to retrieve data from patient medical records. 56% of the subjects had experienced at least one type of trauma. The intensity of perceptual abnormalities was significantly higher in the group with a history of physical abuse and 'other trauma' compared to those without a trauma history. Physical abuse was related to higher levels of visual disturbances, suspiciousness, grandiose beliefs and low mood compared to those without a history of physical abuse. Sexual trauma was related to perceptual disturbances with abusive content and PTSD symptoms. The prevalence of previous trauma in people at UHR of developing psychosis is high. Our findings tentatively suggest that different types of trauma may impact differently on initial presentation to UHR services.
The development of a randomised controlled trial testing the effects of an online intervention among school students at risk of suicide
Publisher: Springer Science and Business Media LLC
Date: 27-05-2014
Structural Brain Imaging Evidence for Multiple Pathological Processes at Different Stages of Brain Development in Schizophrenia
Publisher: Oxford University Press (OUP)
Date: 27-07-2005
Abstract: The underlying neurobiology of emerging psychotic disorders is not well understood. While there is evidence from structural imaging and other studies supporting the popular notion that schizophrenia arises as a consequence of an "early neurodevelopmental" lesion, more recent findings challenge this notion. Evidence, including our own data, suggests that dynamic brain changes occur during the earliest stages of a psychotic illness, including around the time of transition to illness. In this article we review the available longitudinal and relevant cross-sectional structural neuroimaging studies focusing on both the very early neurodevelopmental markers (pre- or perinatal origin) and the later markers (late neurodevelopmental) around the period of transition to illness. Based on our review of recent findings, we suggest that the onset of psychosis is a time of active brain changes, wherein, for a proportion of in iduals, (i) an early (pre- and perinatal) neurodevelopmental lesion renders the brain vulnerable to anomalous late (particularly postpubertal) neurodevelopmental processes, as indicated by evidence for accelerated loss of gray matter and aberrant connectivity particularly in prefrontal regions and (ii) these anomalous neurodevelopmental processes interact with other causative factors associated with the onset of psychosis (e.g., substance use, stress, and dysregulation of the hypothalamic-pituitary-adrenal axis function), which together have neuroprogressive sequelae involving medial temporal and orbital prefrontal regions, as suggested by imaging studies around transition to active illness. However, the pathological processes underlying such progressive changes during "late neurodevelopment" remain unclear but may reflect anomalies of synaptic plasticity, abnormal brain maturation, the adverse effects of stress, or other environmental factors. In this context, the features of schizophrenia, including the neuropsychological deficits and behavioral manifestations, can be understood as direct effects of these multiple pathological processes at various neurodevelopmental stages, including genetic and nongenetic etiological factors.
FC2B CO-MORBIDITY IN UHR CLIENTS: INTAKE AND 12-MONTH AXIS I DIAGNOSES.
Publisher: Elsevier BV
Date: 10-2006
Experience of trauma and conversion to psychosis in an ultra‐high‐risk (prodromal) group
Publisher: Wiley
Date: 13-04-2010
DOI: 10.1111/J.1600-0447.2010.01542.X
Abstract: We aimed to replicate a recent finding of high prevalence of trauma history in patients at 'ultra-high risk' (UHR) of psychotic disorder and to investigate whether trauma predicts conversion to psychosis in this population. A consecutive s le of UHR patients was assessed. History of trauma was accessed with the General Trauma Questionnaire. Cox regression models were used to explore relationship between conversion to psychosis and trauma. Of 92 UHR patients nearly 70% had experienced a traumatic event and 21.7% developed psychosis during follow-up (mean 615 days). Patients who had experienced a sexual trauma (36%) were significantly more likely to convert to first-episode psychosis (OR 2.96) after controlling for meeting multiple UHR intake groups. UHR patients have a high prevalence of history of trauma. Previous sexual trauma may be a predictor of onset of psychotic disorder in this population.
Exercise as an intervention for first-episode psychosis: a feasibility study
Publisher: Wiley
Date: 14-03-2016
DOI: 10.1111/EIP.12329
ANOMALOUS SELF-EXPERIENCE IN THE PRODROMAL PHASE OF SCHIZOPHRENIA AND OTHER PSYCHOTIC DISORDERS
Publisher: Elsevier BV
Date: 04-2010
Insular cortex gray matter changes in individuals at ultra-high-risk of developing psychosis
Publisher: Elsevier BV
Date: 06-2009
DOI: 10.1016/J.SCHRES.2009.03.024
Abstract: Morphologic abnormalities of the insular cortex have been described in psychotic disorders such as schizophrenia, but it remains unclear whether these changes predate the onset of psychosis or develop progressively over the course of illness. In this study, we used magnetic resonance imaging to investigate the gray matter volume of the long and short insular cortices in 97 neuroleptic-naïve in iduals at ultra-high-risk (UHR) for developing psychosis [of whom 31 (32%) later developed psychosis (UHR-P) and 66 (68%) did not (UHR-NP)] and 55 age- and gender-matched healthy comparisons. We also conducted a longitudinal comparison of the insular cortex gray matter changes in 31 UHR in iduals (20 UHR-NP and 11 UHR-P) and 20 controls for whom follow-up MRI data between 1 and 4 years later were available. In the cross-sectional comparison, the UHR-P subjects had a significantly smaller insular cortex compared with the UHR-NP subjects bilaterally and with the controls on the right hemisphere, especially for the short insular region. More severe negative symptoms in UHR-P subjects at baseline were associated with smaller volumes of the right long insular cortex. In the longitudinal comparison, the UHR-P subjects showed greater gray matter reduction of insular cortex bilaterally (-5.0%/year) compared with controls (-0.4%/year) or UHR-NP subjects (-0.6%/year). Our findings suggest that insular cortex gray matter abnormalities in psychotic disorders may reflect pre-existing vulnerability, but that there are also active progressive changes of the insular cortex during the transition period into psychosis. Whether these longitudinal changes are features of the disorder or related to treatment with antipsychotic medication remains to be determined.
Discrete Alterations of Brain Network Structural Covariance in Individuals at Ultra-High Risk for Psychosis
Publisher: Elsevier BV
Date: 06-2015
DOI: 10.1016/J.BIOPSYCH.2014.10.023
Abstract: Investigation of aberrant large-scale brain networks offers novel insight into the role these networks play in erse psychiatric disorders such as schizophrenia. Although studies report altered functional brain connectivity in participants at ultra-high risk (UHR) for psychosis, it is unclear whether these alterations extend to structural brain networks. Whole-brain structural covariance patterns of 133 participants at UHR for psychosis (51 of whom subsequently developed psychosis) and 65 healthy control (HC) subjects were studied. Following data preprocessing (using VBM8 toolbox), the mean signal in seed regions relating to specific networks (visual, auditory, motor, speech, semantic, executive control, salience, and default-mode) were extracted, and voxel-wise analyses of covariance were conducted to compare the association between whole-brain signal and each seed region for UHR and HC in iduals. The UHR participants who transitioned to psychosis were compared with the UHR participants who did not. Significantly reduced structural covariance was observed in the UHR s le compared with the HC s le for the default-mode network, and increased covariance was observed for the motor and executive control networks. When the UHR participants who transitioned to psychosis were compared with the UHR participants who did not, aberrant structural covariance was observed in the salience, executive control, auditory, and motor networks. Whole-brain structural covariance analyses revealed subtle changes of connectivity of the default-mode, executive control, salience, motor, and auditory networks in UHR in iduals for psychosis. Although we found significant differences, these are small changes and tend to reflect largely intact structural networks.
Longitudinal determinants of client treatment satisfaction in an intensive first‐episode psychosis treatment programme
Publisher: Wiley
Date: 10-03-2016
DOI: 10.1111/EIP.12323
Abstract: Previous evidence demonstrates that higher treatment satisfaction is strongly associated with improved clinical outcomes and functioning. The aim of the current study is to explore potential associations between clinical and demographic attributes, as well as changes in role, social and cognitive functioning occurring over the course of treatment, on self-reported treatment satisfaction within the context of an intensive first-episode psychosis intervention programme. Forty-four young adults attending a first-episode psychosis treatment programme completed a battery of clinical and neuropsychological measures at intake to the programme and again after 6 months of treatment. A modified version of the Client Satisfaction Questionnaire was administered at 6 months. Baseline, 6-month and change scores across the clinical and demographic measures were examined relative to the satisfaction questionnaire to evaluate determinants of treatment satisfaction. Better premorbid adjustment during childhood and early adolescence was associated with higher treatment satisfaction, as did positive changes in clients' cognitive performance and their use of humour as a coping strategy. Clients' use of emotional support as a coping strategy at 6 months was also positively associated with treatment satisfaction. Although clients' social and role functioning improved significantly during the 6-month treatment window, changes in functional outcomes were not significantly associated with treatment satisfaction. The current study highlights the role of premorbid adjustment and changes in coping and neurocognition as factors influencing treatment satisfaction. Future research designs might be able to more specifically ascertain causal relationships between patient characteristics, treatment components, client satisfaction and clinical effects.
Borderline Personality Features And Development Of Psychosis In An 'ultra High Risk' (Uhr) Population: A Case Control Study
Publisher: Wiley
Date: 05-06-2012
DOI: 10.1111/J.1751-7893.2012.00365.X
Abstract: There is clinical uncertainty as to whether borderline personality disorder (BPD) traits in those with an 'at risk mental state' have an effect on the risk of 'transition' to psychosis. We aimed to investigate the relationship between baseline BPD features, risk of transition and type of psychotic disorder experienced. This is a case-control study of 'ultra high risk' (UHR) for psychosis patients treated at the clinic, between 2004 and 2007. 'Cases' were UHR in iduals who made the 'transition' to full threshold psychotic disorder within 24 months 'control' group was a matched UHR s le who had not developed a psychotic disorder at 24 months. In iduals were matched on time of entry to the clinic, age and gender. Diagnostic and statistical manual of mental disorders, fourth edition (DSM-IV) BPD features were assessed from clinical assessments using a structured instrument (Structured Clinical Interview for DSM-IV Axis II Disorder for BPD (SCID-II BPD)). Psychosis diagnosis following transition was rated from the clinical files using the operational criteria in studies of psychotic illness (OPCRIT) computer algorithm. The number of BPD traits and number with full threshold BPD were compared in those who developed psychosis and those who did not. We analysed data from 48 cases and 48 controls. There was no statistically significant difference in the rate of transition to psychosis for those with baseline full-threshold BPD, compared with those without BPD. The number of BPD traits or number with full threshold BPD did not differ by psychosis diagnosis grouping. Co-occurring BPD or BPD features does not appear to strongly influence the risk of short-term transition to psychosis or the risk of developing a non-affective psychotic disorder in this population.
ULTRA HIGH RISK (UHR) FOR PSYCHOSIS GROUPS: ARE THERE DIFFERENT LEVELS OF RISK FOR TRANSITION TO PSYCHOSIS?
Publisher: Elsevier BV
Date: 04-2010
Social cognition in clinical “at risk” for psychosis and first episode psychosis populations
Publisher: Elsevier BV
Date: 11-2012
DOI: 10.1016/J.SCHRES.2012.08.007
Abstract: Social cognitive deficits have been demonstrated in first episode psychosis (FEP) and groups at high risk for developing psychosis but the relative degree of deficit between these groups is unclear. Such knowledge may further our understanding of the importance of these deficits in the development of psychosis. The study aimed to compare the degree of impairment in social cognition in three groups: FEP, those at "ultra high risk" (UHR) for psychosis and healthy controls. UHR and FEP patients were recruited from an established youth mental health service in Melbourne. Three domains of social cognition were assessed: ToM (hinting task and interpretation of visual jokes) facial and vocal emotion recognition (Diagnostic Assessment of Non Verbal Accuracy) social perception (Mayer-Salovey-Caruso Emotional Intelligence Test - managing emotions branch). Group differences were analysed using Analysis of Covariance with age, gender and IQ as covariates. Data on 30 UHR, 40 FEP and 30 control participants were analysed. FEP patients performed significantly worse on all social cognition tasks compared to controls. For the UHR group, scores were intermediate between FEP and controls for all tasks, but only significantly different to controls for ToM tasks. Effects sizes were largest for the ToM tasks and the emotion recognition task for both patient groups. There were no significant differences between UHR and FEP patients in performance on any of the tasks. Social cognition is generally impaired in FEP patients but there are fewer deficits in a UHR group. Longitudinal research in larger s les is needed to investigate whether social cognition deficits, such as ToM are risk factors in UHR groups for subsequent transition to full-threshold psychosis.
Medium term follow-up of a randomized controlled trial of interventions for young people at ultra high risk of psychosis
Publisher: Elsevier BV
Date: 11-2007
DOI: 10.1016/J.SCHRES.2007.05.018
Abstract: Valid criteria to identify young people who are believed to be at ultra high risk (UHR) of developing a psychotic episode were developed over the last decade. The first randomized controlled trial of treatment in a UHR cohort indicated that specific pharmacotherapy and psychotherapy delayed onset of disorder, and possibly reduced incidence. This paper reports results of follow-up of that trial. 41 of the 59 (69.5%) participants in the original study agreed to follow-up. No differences were found in transition rate, level of symptomatology or functioning between participants who received a combination of psychological treatment and anti-psychotic medication compared to those who received supportive therapy alone. A significant proportion of both treatment groups reported moderate levels of psychiatric morbidity and a continuing need and desire for care at this follow-up. Low levels of hospitalisation were noted for those who did progress to psychosis. Conclusions that can be drawn from this exploratory study are limited by the relatively small number of participants in the original study and the failure to follow-up the entire cohort. Although participants may have been treated too briefly to result in enduring positive effects, there appear to have been some cost savings in inpatient mental health treatment required after the end of the trial for in iduals in both treatment groups who developed psychosis.
Serum antibodies against Toxoplasma gondii are associated with more positive symptoms in individuals at ultra-high risk for psychosis
Publisher: Elsevier BV
Date: 10-2006
Exploring functional impairment in young people at ultra‐high risk for psychosis: A qualitative study
Publisher: Wiley
Date: 07-03-2018
DOI: 10.1111/EIP.12560
Abstract: Many young people at ultra-high risk (UHR) of developing psychosis exhibit marked and persistent impairments in social and occupational functioning. We aimed to explore UHR patients' subjective experiences of these difficulties and their causes. We conducted semi-structured interviews with 20 UHR in iduals recruited from Early Detection and Intervention Teams in Northwest England. Topics covered included how participants spent their time, their interpersonal relationships, academic and occupational performance, premorbid functioning and clinical treatment. Thematic analysis was used to examine the prevailing themes. The s le included in iduals with varying degrees of functional impairment, ranging from mild to severe difficulties in functioning. Analysis of the qualitative data elicited themes around 2 topics: breadth of functional difficulties and subjective reasons for poor functioning. Participants reported a range of impairments in their social and occupational functioning which they attributed to a combination of clinical, cognitive and psychological factors. These included variables previously identified in the quantitative literature such as psychiatric symptoms, adverse life experiences and cognitive deficits. However, our findings also included other factors which have received comparably little attention such as self-stigmatizing attitudes and dysfunctional metacognitive beliefs. We propose a model that attempts to explain how these variables interact to drive and sustain functional impairment in the UHR population. This will assist in the development of clinical interventions aimed at promoting functional recovery among UHR in iduals.
Imported Malaria Treated in Melbourne, Australia: Epidemiology and Clinical Features in 246 Patients
Publisher: Oxford University Press (OUP)
Date: 08-03-2006
Abstract: Imported malaria is increasing in nonendemic countries, including Australia. The objective of this study was to describe the epidemiology and clinical features of travelers with imported malaria presenting to a specialist infectious diseases hospital. A retrospective case series of 246 consecutively admitted inpatients with laboratory confirmed malaria. The main outcome measures were the proportion of patients infected with each malaria species, and relationship between species and country of birth, area of acquisition, adequacy of chemoprophylaxis, clinical features, laboratory investigations, and treatment. Plasmodium vivax caused 182 (68.9%) episodes, Plasmodium falciparum caused 71 (26.9%), Plasmodium ovale caused 5 (1.9%), and Plasmodium malariae 1 (0.4%). Fifty-six percent of patients reported chemoprophylaxis use. People born in a country with endemic malaria (36.6%) were less likely to have used chemoprophylaxis. Malaria was most commonly acquired in Papua New Guinea and Southeast Asia. The median times to diagnosis after return to Australia for P. falciparum and P. vivax infections were 1 and 9 weeks respectively. The longest interval between last arrival in Australia and presentation with P. falciparum malaria was 32 weeks. Fever (96%), headache (74%), and a tender or palpable spleen (40%), were the most common clinical features. Diarrhea was more common in P. falciparum, and rigors in P. vivax infections. Thrombocytopenia (71%), abnormal liver function tests and an elevated C-reactive protein (85%) were common. Six patients had severe falciparum malaria but no deaths occurred during the study period. Malaria remains a health threat for those traveling in endemic areas and is associated with failure to use chemoprophylaxis appropriately. Nonspecific clinical features may lead to delayed diagnosis and misdiagnosis. Malaria should be suspected in the febrile traveler, regardless of birthplace, prophylaxis, symptomatology, or the time that has elapsed since leaving the malarious area.
Intervention in Individuals at Ultra-High Risk for Psychosis
Publisher: Physicians Postgraduate Press, Inc
Date: 30-06-2009
DOI: 10.4088/JCP.08R04472
How should physical exercise be used in schizophrenia treatment?
Publisher: Informa UK Limited
Date: 28-12-2016
TC3C GENERALISED AND SPECIFIC COGNITIVE VULNERABILITY MARKERS FOR PSYCHOSIS: LATEST FINDINGS FROM AN ULTRA HIGH RISK COHORT
Publisher: Elsevier BV
Date: 10-2006
The role of coping in the association between subclinical psychotic experiences and functioning: A within study replication in two independent adolescent samples
Publisher: Elsevier BV
Date: 11-2018
DOI: 10.1016/J.SCHRES.2018.05.022
Abstract: An inverse association between psychosocial functioning and psychotic experiences is now established in both clinical and non-clinical populations, however the mechanisms which drive this are unclear. Adolescents with subclinical psychotic experiences (SPE) are more likely to use maladaptive coping strategies and less likely to use adaptive ones, and maladaptive coping has also been associated with poor functioning. A within study replication in two adolescent s les from the general populations of Melbourne, Australia (n = 723) and Birmingham, United Kingdom (n = 239), was conducted to determine whether the association between SPE and psychosocial functioning is mediated by coping style. SPE were associated with reduced general and family functioning and to a lesser extent with reduced peer functioning. Task-oriented (focusing on solving the problem) and emotion-oriented (negative emotional responses) coping were found to mediate the relationship between SPE and three types of functioning in both the Melbourne and the Birmingham s les. The within study replication consistently found that coping style mediates SPE and psychosocial functioning, despite significant differences in age, gender, functioning, use of coping styles, and level of SPE between the two s les. Longitudinal research is needed to fully understand any causal role coping may play in the relationship between SPE and poor functioning. The results have important public health and clinical implications, and suggest that techniques which increase levels of adaptive coping and reduce levels of maladaptive coping (in particular emotion-oriented styles) may help to break the cycle between SPE, functional decline, and eventual need for care.
HOW EFFECTIVE ARE OMEGA-3 FATTY ACIDS FOR THE TREATMENT OF THE PSYCHOSIS PRODROME?
Publisher: Elsevier BV
Date: 04-2012
Outcome of Suicidal Ideation and Behavior in a Young, Help-Seeking Population over a 2-Year Period
Publisher: Hogrefe Publishing Group
Date: 2007
Abstract: Abstract. Suicidal behavior is associated with negative outcomes, including completed suicide. This study examined the prevalence of suicidal behavior in a s le of referrals to a youth psychiatric service and investigated the stability of suicidality over 2 years. Of the 140 people (mean age 17.8) who were referred to a youth psychiatric service, 82 who were accepted for treatment (RA group) and 58 who were not accepted (RNA group) were assessed 57% reported considering suicide and 39% reported attempting suicide in the 12 months prior to referral. Participants who reported suicidal ideation were significantly more likely than nonsuicidal participants to have multiple Axis I diagnoses and lower levels of functioning. At the 2-year follow-up there was a significant reduction in suicidality in the RA group, but not in the RNA group. In conclusion, suicidality is prevalent among young people referred to psychiatric services. Even brief contact with services results in a reduction in suicidality over 2 years.
Perceived stress and psychosis: The effect of perceived stress on psychotic‐like experiences in a community sample of adolescents
Publisher: Wiley
Date: 03-02-2019
DOI: 10.1111/EIP.12795
Abstract: Psychotic-like experiences (PLE) are sub-threshold, non-clinical forms of psychosis which can place an in idual at greater risk of development of a psychotic disorder. Subtypes of PLE have also been shown to exist (bizarre experiences, persecutory ideation, perceptual abnormalities and magical thinking). Perceived stress relates to how two in iduals may deal with the same objectively stressful event in different ways. The objective of our study was to investigate the extent to which perceived stress is associated with PLE in a community s le of adolescents, whether certain subtypes of PLE correlate more with perceived stress than others and to explore the role of depression with these associations. A total of 655 students completed the community assessment of psychic experiences (CAPE) and perceived stress scale (PSS). Pearson's correlation was used to investigate the relationship between PSS and CAPE and also between perceived stress and the four subtypes of PLE. Regression then explored the effect of perceived stress on PLE when accounting for depressive symptomatology. Positive correlation was found between PSS and total CAPE (r = 0.405, P = 0.000). Positive significant correlation was also found between PSS and each subtype of PLE, with persecutory ideation correlating the strongest and magical thinking the least. Perceived stress was significantly associated with PLE even after adjusting for depression. We recommend that more regular screening of perceived stress in adolescent populations could lead to earlier recognition of PLE. Early treatment has shown to reduce rates of transition to psychosis, and so could benefit our adolescent community in the future.
Prediction of psychosis - A step towards indicated prevention of schizophrenia
Publisher: Royal College of Psychiatrists
Date: 06-1998
DOI: 10.1192/S0007125000297602
Abstract: Background The identification of people at high risk of becoming psychotic within the near future creates opportunities for early intervention prior to the onset of psychosis to prevent or minimise later ill-health. The present study combines current knowledge about risk factors for schizophrenia with our knowledge of psychotic prodromes in an attempt to identify a group particularly vulnerable to impending psychosis. We wanted to identify people with high likelihood of transition to psychosis within a follow-up period of 12 months, and to determine the rate of transition to psychosis in this group. Method Various state and trait risk factors for psychosis were used alone and in combination to operationally define a putatively high-risk group. Operationalised criteria for onset of psychosis were established. The in iduals were assessed monthly on measures of psychopathology for six months. Results Eight out of 20 people made the transition to frank psychosis within a six-month follow-up period. Follow-up of this group is still in progress, and the 12 month transition rate might prove to be higher still. Conclusions We have demonstrated that it is possible to identify in iduals with a high likelihood of onset of psychosis within a brief follow-up period. This lays the foundation for early treatment in an attempt to prevent, delay or minimise the severity of first onset of schizophrenia.
Young people at ultra high risk for psychosis: A research update
Publisher: Wiley
Date: 06-01-2011
DOI: 10.1111/J.1751-7893.2010.00241.X
Abstract: Over the last fifteen years attempts have been made to prospectively identify in iduals in the prodromal phase of schizophrenia and other psychotic disorders. The 'ultra high risk' approach, based on a combination of known trait and state risk factors, has been the main strategy used. The validation of the ultra high risk criteria led to a series of intervention studies in this population. The aim of this paper is to provide an overview of ultra high risk research. We review studies in this area, focusing on intervention research. Intervention studies have included the use of low dose antipsychotic medication, cognitive therapy, and omega-3 fatty acids. The evidence for specific intervention strategies for this population is moderate and requires replication with larger s les. Recently, it has been proposed to include an adaption of the ultra high risk criteria in the next version of the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition). This has raised some controversy in the field. The authors conclude that it would be premature to include the Risk Syndrome in the Diagnostic and Statistical Manual of Mental Disorders at this stage.
The effects and determinants of exercise participation in first-episode psychosis: a qualitative study
Publisher: Springer Science and Business Media LLC
Date: 20-02-2016
Motivating factors and barriers towards exercise in severe mental illness: a systematic review and meta-analysis
Publisher: Cambridge University Press (CUP)
Date: 09-08-2016
DOI: 10.1017/S0033291716001732
Abstract: Exercise can improve clinical outcomes in people with severe mental illness (SMI). However, this population typically engages in low levels of physical activity with poor adherence to exercise interventions. Understanding the motivating factors and barriers towards exercise for people with SMI would help to maximize exercise participation. A search of major electronic databases was conducted from inception until May 2016. Quantitative studies providing proportional data on the motivating factors and/or barriers towards exercise among patients with SMI were eligible. Random-effects meta-analyses were undertaken to calculate proportional data and 95% confidence intervals (CI) for motivating factors and barriers toward exercise. From 1468 studies, 12 independent studies of 6431 psychiatric patients were eligible for inclusion. Meta-analyses showed that 91% of people with SMI endorsed ‘improving health’ as a reason for exercise ( N = 6, n = 790, 95% CI 80–94). Among specific aspects of health and well-being, the most common motivations were ‘losing weight’ (83% of patients), ‘improving mood’ (81%) and ‘reducing stress’ (78%). However, low mood and stress were also identified as the most prevalent barriers towards exercise (61% of patients), followed by ‘lack of support’ (50%). Many of the desirable outcomes of exercise for people with SMI, such as mood improvement, stress reduction and increased energy, are inversely related to the barriers of depression, stress and fatigue which frequently restrict their participation in exercise. Providing patients with professional support to identify and achieve their exercise goals may enable them to overcome psychological barriers, and maintain motivation towards regular physical activity.
Comparison of erythrocyte omega-3 index, fatty acids and molecular phospholipid species in people at ultra-high risk of developing psychosis and healthy people
Publisher: Elsevier BV
Date: 12-2020
DOI: 10.1016/J.SCHRES.2019.06.020
Abstract: People classified as ultra-high risk (UHR) of developing psychosis have reduced cellular membrane omega-3 and omega-6 polyunsaturated fatty acids (PUFA). We aimed to compare omega-3 index, fatty acids and molecular phospholipid species from erythrocytes of people with UHR (n = 285) with age-matched healthy controls (n = 120) assessed by mass spectrometry. Lower proportions of PUFA were observed in the UHR group compared to healthy controls specifically, eicosapentaenoic acid (EPA) was 29.3% lower, docosahexaenoic acid (DHA) was 27.2% lower, arachidonic acid (AA) was 15.8% lower and the omega-3 index was 26.9% lower. The AA to EPA ratio was higher in the UHR group compared to the healthy group. Smoking status had no significant effect on PUFA levels in healthy or the UHR groups. BMI was associated with PUFA levels in the UHR group only and the statistical model only explains 2% of the variance of the PUFA levels. The proportion of nervonic acid was 64.4% higher in the UHR group compared to healthy controls. At a lipid class level, the UHR group had 16% higher concentrations of sphingomyelin (SM) and 46% lower concentrations phosphatidylethanolamine (PE) compared to healthy group. Of the 49 in idual molecular phospholipids, twenty-seven phospholipid species were lower in the UHR group. In conclusion, there are clear differences in the proportions of erythrocyte fatty acids and phospholipids between UHR and healthy controls and UHR had higher concentrations of SM and lower concentrations of PE. These differences may represent a promising prodromal risk biomarker in the UHR population to aid clinical diagnosis.
Ecological momentary assessment and beyond: The rising interest in e-mental health research
Publisher: Elsevier BV
Date: 09-2016
When things are not as they seem: Detecting first-episode psychosis upon referral to ultra high risk ('prodromal') clinics
Publisher: Wiley
Date: 05-2007
Public and Private Psychiatry: Can They Work Together and is it Worth the Effort?
Publisher: SAGE Publications
Date: 2005
DOI: 10.1080/J.1440-1614.2005.01511.X
Abstract: Objective: Partnerships in mental health care, particularly between public and private psychiatric services, are being increasingly recognized as important for optimizing patient management and the efficient organization of services. However, public sector mental health services and private psychiatrists do not always work well together and there seem to be a number of barriers to effective collaboration. This study set out to investigate the extent of collaborative ‘shared care’ arrangements between a public mental health service and private psychiatrists practising nearby. It also examined possible barriers to collaboration and some possible solutions to the identified problems. Method: A questionnaire examining the above factors was sent to all public sector mental health clinicians and all private psychiatrists in the area. Results: One hundred and five of the 154 (68.2%) public sector clinicians and 103 of the 194 (53.1%) private psychiatrists returned surveys. The main barriers to successful collaboration identified by members of both sectors were: ‘Difficulty communicating’ endorsed by 71.4% of public clinicians and 72% of private psychiatrists, ‘Confusion of roles and responsibilities’ endorsed by 62.9% and 66%, respectively, and ‘Different treatment approach’ by 47.6% and 45.6%, respectively. Over 60% of private psychiatrists identified problems with access to the public system as a barrier to successful shared care arrangements. It also emerged, as hypothesized, that the public and private systems tend to manage different patient populations and that public clinicians in particular are not fully aware of the private psychiatrists' range of expertise. This would result in fewer referrals for shared care across the sectors. Conclusions: A number of barriers to public sector clinicians and private psychiatrists collaborating in shared care arrangements were identified. The two groups surveyed identified similar barriers. Some of these can potentially be addressed by changes to service systems. Others require cultural shifts in both sectors. Improved communications including more opportunities for formal and informal meetings between people working in the two sectors would be likely to improve the understanding of the complementary sector's perspective and practice. Further changes would be expected to require careful work between the sectors on training, employment and practice protocols and initiatives, to allow better use of the existing services and resources.
Randomized comparison of group cognitive behaviour therapy and group psychoeducation in acute patients with schizophrenia: Effects on subjective quality of life
Publisher: SAGE Publications
Date: 02-2010
DOI: 10.3109/00048670903393571
Abstract: Objective: Although the clinical efficacy of cognitive behaviour therapy (CBT) has been established for patients with schizophrenia, the data on effects on quality of life (QoL) are lacking. The purpose of the present study was therefore to compare the effects of a brief group CBT and a group psychoeducational (PE) programme in patients with schizophrenia on QoL. Method: A total of 88 inpatients with schizophrenia were randomized to receive a therapy envelope of 8 weeks including either 16 sessions of group CBT or eight sessions of group PE treatment. QoL was assessed using the Modular System for Quality of Life at baseline, post-treatment assessment and 6 month follow up. Results: QoL improved significantly in both treatments in most QoL dimensions. Within-group effect sizes for general QoL at follow up were 0.25 for CBT and 0.29 for PE. No significant differences between CBT and PE were found at post-treatment and at 6 month follow up. Conclusions: Both brief group CBT and group PE improve subjective QoL in patients with schizophrenia.
SUBTHRESHOLD INTERVENTION TO REDUCE THE IMPACT OF EMERGING PSYCHOSIS AND RISK FOR STAGE PROGRESSION: RECENT AND FUTURE CLINICAL TRIALS
Publisher: Elsevier BV
Date: 04-2014
Early intervention in psychosis: Keeping faith with evidence-based health care
Publisher: Cambridge University Press (CUP)
Date: 24-09-2010
Examining the feasibility, acceptability, validity and reliability of physical activity, sedentary behaviour and sleep measures in people with schizophrenia
Publisher: Elsevier BV
Date: 10-2021
Does Screening High School Students for Psychological Distress, Deliberate Self-Harm, or Suicidal Ideation Cause Distress – And Is It Acceptable?
Publisher: Hogrefe Publishing Group
Date: 09-2011
DOI: 10.1027/0227-5910/A000087
Abstract: Background: Programs designed to detect students at risk of depression and suicidality have shown success ( Shaffer et al., 2004 ). Aims: The current study sought to examine whether or not such a program was acceptable to participants and whether or not it caused distress. Methods: Participants were boys aged 14 to 16. Participants were assessed using an on-line questionnaire acceptability was measured via postal questionnaire. Results: Of 272 participants, 31 (11.4%) were considered at-risk 13 required ongoing support, 8 of whom had not previously sought help. Overall screening did not appear to cause significant undue distress, although some differences were evident between at-risk and not at-risk students. All participants found the program acceptable. Conclusions: When conducted carefully, early detection programs can be an effective and acceptable method of identifying at-risk adolescents.
Neurocognitive predictors of functional outcome two to 13 years after identification as ultra-high risk for psychosis
Publisher: Elsevier BV
Date: 10-2011
DOI: 10.1016/J.SCHRES.2011.06.014
Abstract: Little is known about the relationship between neurocognitive performance and functional outcome before the onset of frank psychosis. This longitudinal study aimed to investigate neurocognitive predictors of poor functional outcome in a group identified as ultra-high risk (UHR) for psychosis between two and 13 years prior. In iduals (N=230) identified as UHR for psychosis at the PACE Clinic in Melbourne completed assessment of psychopathology, functioning and neurocognition at baseline and follow-up. The mean length of follow-up was 7.26 years (SD 3.05). Forty-one in iduals with the poorest functional outcome were identified. Only 48.8% of this group had transitioned to psychosis. Poor functional outcome was associated with reduced performance at baseline in the specific neurocognitive domains of verbal learning and memory, processing speed and attention, and verbal fluency, but not global cognitive impairment. Reduced performance on a verbal story recall task, in combination with higher negative symptoms at baseline, was the best predictor of later poor outcome. Baseline positive psychotic symptoms and GAF scores were not associated with later poor outcome. To date, this is the longest follow-up study of an UHR s le. Poor functional outcome was associated with specific neurocognitive decrements, regardless of transition to psychosis. The detection of in iduals with poor functioning at follow-up, against a background of previously identified risk factors for psychotic disorder, may yield a valid group in which to study biomarkers and treatment of schizophrenia.
Adjunctive nutrients in first-episode psychosis: A systematic review of efficacy, tolerability and neurobiological mechanisms
Publisher: Wiley
Date: 21-03-2018
DOI: 10.1111/EIP.12544
Social cognition in multiple sclerosis
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 21-09-2016
Prolonged duration of untreated psychosis: a problem that needs addressing
Publisher: Wiley
Date: 23-01-2017
DOI: 10.1111/EIP.12308
Abstract: The duration of untreated psychosis (DUP) refers to the period of time between the emergence of psychotic symptoms and the initiation of appropriate clinical treatment. Prolonged DUP is associated with a range of adverse consequences, including more severe illness course, cognitive deficits and poor functioning. Problems with recognition of illness and in seeking help contribute to DUP, but another major cause of prolonged DUP is delays within secondary mental health services. In an attempt to reduce these delays, National Health Service England and the Department of Health have set new targets to improve access to early intervention services which will come into effect in April 2016. Given this background, we aimed to examine the DUP and pathways to care of new patients entering an early intervention service. We also examined whether they were receiving National Institute for Health and Care Excellence (NICE) concordant treatment. This will enable us to establish a baseline so that the impact of the new targets can be determined and to assess the degree of change that will be required to implement these. De-identified electronic records of 165 patients accepted into the service over a 12-month period were analysed. Median DUP was 6 months. There was a median of 2 contacts prior to service entry. Community Mental Health Teams were the largest source of referrals. The majority of patients had a DUP exceeding the international target of 3 months. The findings appear to support previous evidence that this may be partially attributable to significant delays within the mental health care system.
The relationship between coping and subclinical psychotic experiences in adolescents from the general population – a longitudinal study – CORRIGENDUM
Publisher: Cambridge University Press (CUP)
Date: 25-07-2011
Examining the physical health and lifestyle of young people at ultra-high risk for psychosis: A qualitative study involving service users, parents and clinicians
Publisher: Elsevier BV
Date: 09-2017
DOI: 10.1016/J.PSYCHRES.2017.05.023
Abstract: Emerging evidence suggests young people at ultra-high risk for psychosis (UHR) are also at-risk for poor physical health, and display high rates of modifiable cardiometabolic risk factors. However, before we can develop effective interventions there is a need to understand factors affecting lifestyle choices in the UHR group. We conducted semi-structured qualitative interviews with 20 UHR in iduals (50% male mean age 21.7), 5 parents (4 mothers, 1 father), and 6 clinicians from early intervention services in the Northwest of England to identify barriers and facilitators to living a healthy lifestyle, including achieving regular exercise, eating well and refraining from excessive substance use. Thematic analysis revealed the main barriers to living a healthy lifestyle related to psychiatric symptoms, beliefs about self, social withdrawal and practical considerations such as accessibility and cost. Provision of social support and promoting autonomy emerged as the two main themes which would facilitate a healthy lifestyle. Promoting physical health in people with emerging symptoms of psychosis is an important, yet neglected area of mental health practice and warrants further investigation. UHR in iduals experience numerous barriers to living a healthy lifestyle, and interventions should focus primarily on targeting autonomous motivation and providing social support to facilitate this change.
Monitoring and care of young people at incipient risk of psychosis
Publisher: Oxford University Press (OUP)
Date: 1996
Abstract: This article describes the theoretical background, origins, and development of a new clinical service for intervention in the putatively prodromal phase of schizophrenia and other psychotic disorders. Establishing such a service required examination of conceptual issues such as the meaning of the prodrome in psychosis and its association with risk of subsequent psychosis, and of practical issues related to identifying prodromal patients in the community and engaging them in monitoring and treatment. Patients' needs, timing, and mode of treatment had to be considered. Preliminary data from the service's 20-month pilot phase are presented to help inform these issues.
Cardiometabolic risk factors in young people at ultra-high risk for psychosis: A systematic review and meta-analysis
Publisher: Elsevier BV
Date: 02-2016
DOI: 10.1016/J.SCHRES.2016.01.010
Abstract: The physical health of people with schizophrenia is poor, and associated with increased morbidity and mortality. Unhealthy lifestyles and side-effects of antipsychotic medication contribute to cardiometabolic dysfunction. Yet it is unclear when this unhealthy profile starts. We aimed to see if people at ultra-high risk for psychosis (UHR) have increased rates of cardiometabolic risk factors. An electronic search of MEDLINE, PsycINFO, Embase and the Cochrane Central Register of Controlled Trials was conducted on 1st May 2015 using terms associated with the ultra-high risk state and health. Eligible studies were peer-reviewed English language research articles with populations that met at-risk diagnostic criteria and reported cardiometabolic risk factors. A meta-analysis was conducted on smoking data, the cardiometabolic risk factor that yielded the most studies. Forty-seven eligible studies were identified. UHR s les had low levels of physical activity, and high rates of smoking and alcohol abuse compared with controls. No differences were found for body mass index. An overall pooled rate of smoking for UHR participants was 33% (95% CI=0.24-0.42) and significantly more UHR in iduals smoked compared with controls with a pooled odds ratio of 2.3 (P<0.05 95% CI=-1.48-3.48). UHR s les display cardiometabolic risk factors which are largely modifiable. The UHR phase is an important opportunity for early intervention services to improve physical health.
Evidence-based guidelines for the pharmacological treatment of schizophrenia: Updated recommendations from the British Association for Psychopharmacology
Publisher: SAGE Publications
Date: 12-12-2019
Abstract: These updated guidelines from the British Association for Psychopharmacology replace the original version published in 2011. They address the scope and targets of pharmacological treatment for schizophrenia. A consensus meeting was held in 2017, involving experts in schizophrenia and its treatment. They were asked to review key areas and consider the strength of the evidence on the risk-benefit balance of pharmacological interventions and the clinical implications, with an emphasis on meta-analyses, systematic reviews and randomised controlled trials where available, plus updates on current clinical practice. The guidelines cover the pharmacological management and treatment of schizophrenia across the various stages of the illness, including first-episode, relapse prevention, and illness that has proved refractory to standard treatment. It is hoped that the practice recommendations presented will support clinical decision making for practitioners, serve as a source of information for patients and carers, and inform quality improvement.
Caudate volume changes across three stages of psychosis
Publisher: Elsevier BV
Date: 1998
Study protocol: The development of a pilot study employing a randomised controlled design to investigate the feasibility and effects of a peer support program following discharge from a specialist first-episode psychosis treatment centre
Publisher: Springer Science and Business Media LLC
Date: 25-05-2010
Examining the association between social cognition and functioning in individuals at ultra-high risk for psychosis
Publisher: SAGE Publications
Date: 19-07-2017
Abstract: Social and role functioning are compromised for the majority of in iduals at ultra-high risk of psychosis, and it is important to identify factors that contribute to this functional decline. This study aimed to investigate social cognitive abilities, which have previously been linked to functioning in schizophrenia, as potential factors that impact social, role and global functioning in ultra-high risk patients. A total of 30 ultra-high risk patients were recruited from an established at-risk clinical service in Melbourne, Australia, and completed a battery of social cognitive, neurocognitive, clinical and functioning measures. We examined the relationships between all four core domains of social cognition (emotion recognition, theory of mind, social perception and attributional style), neurocognitive, clinical and demographic variables with three measures of functioning (the Global Functioning Social and Role scales and the Social and Occupational Functioning Assessment Scale) using correlational and multiple regression analyses. Performance on a visual theory of mind task (visual jokes task) was significantly correlated with both concurrent role ( r = 0.425, p = 0.019) and global functioning ( r = 0.540, p = 0.002). In multivariate analyses, it also accounted for unique variance in global, but not role functioning after adjusting for negative symptoms and stress. Social functioning was not associated with performance on any of the social cognition tasks. Among specific social cognitive abilities, only a test of theory of mind was associated with functioning in our ultra-high risk s le. Further longitudinal research is needed to examine the impact of social cognitive deficits on long-term functional outcome in the ultra-high risk group. Identifying social cognitive abilities that significantly impact functioning is important to inform the development of targeted intervention programmes for ultra-high risk in iduals.
The impact of early intervention in schizophrenia
Publisher: Springer New York
Date: 05-09-2010
The mitochondrial outer membrane AAA ATP ase AtOM 66 affects cell death and pathogen resistance in A rabidopsis thaliana
Publisher: Wiley
Date: 27-10-2014
DOI: 10.1111/TPJ.12665
Abstract: One of the most stress-responsive genes encoding a mitochondrial protein in Arabidopsis (At3g50930) has been annotated as AtBCS1 (cytochrome bc1 synthase 1), but was previously functionally uncharacterised. Here, we show that the protein encoded by At3g50930 is present as a homo-multimeric protein complex on the outer mitochondrial membrane and lacks the BCS1 domain present in yeast and mammalian BCS1 proteins, with the sequence similarity restricted to the AAA ATPase domain. Thus we propose to re-annotate this protein as AtOM66 (Outer Mitochondrial membrane protein of 66 kDa). While transgenic plants with reduced AtOM66 expression appear to be phenotypically normal, AtOM66 over-expression lines have a distinct phenotype, showing strong leaf curling and reduced starch content. Analysis of mitochondrial protein content demonstrated no detectable changes in mitochondrial respiratory complex protein abundance. Consistent with the stress inducible expression pattern, over-expression lines of AtOM66 are more tolerant to drought stress but undergo stress-induced senescence earlier than wild type. Genome-wide expression analysis revealed a constitutive induction of salicylic acid-related (SA) pathogen defence and cell death genes in over-expression lines. Conversely, expression of SA marker gene PR-1 was reduced in atom66 plants, while jasmonic acid response genes PDF1.2 and VSP2 have increased transcript abundance. In agreement with the expression profile, AtOM66 over-expression plants show increased SA content, accelerated cell death rates and are more tolerant to the biotrophic pathogen Pseudomonas syringae, but more susceptible to the necrotrophic fungus Botrytis cinerea. In conclusion, our results demonstrate a role for AtOM66 in cell death and lifying SA signalling.
Early Signs Monitoring to Prevent Relapse in Psychosis and Promote Well-Being, Engagement, and Recovery: Protocol for a Feasibility Cluster Randomized Controlled Trial Harnessing Mobile Phone Technolo
Publisher: JMIR Publications Inc.
Date: 17-06-2019
Abstract: elapse in schizophrenia is a major cause of distress and disability and is predicted by changes in symptoms such as anxiety, depression, and suspiciousness (early warning signs [EWSs]). These can be used as the basis for timely interventions to prevent relapse. However, there is considerable uncertainty regarding the implementation of EWS interventions. his study was designed to establish the feasibility of conducting a definitive cluster randomized controlled trial comparing Early signs Monitoring to Prevent relapse in psychosis and prOmote Well-being, Engagement, and Recovery (EMPOWER) against treatment as usual (TAU). Our primary outcomes are establishing parameters of feasibility, acceptability, usability, safety, and outcome signals of a digital health intervention as an adjunct to usual care that is deliverable in the UK National Health Service and Australian community mental health service (CMHS) settings. We will assess the feasibility of candidate primary outcomes, candidate secondary outcomes, and candidate mechanisms for a definitive trial. e will randomize CMHSs to EMPOWER or TAU. We aim to recruit up to 120 service user participants from 8 CMHSs and follow them for 12 months. Eligible service users will (1) be aged 16 years and above, (2) be in contact with local CMHSs, (3) have either been admitted to a psychiatric inpatient service or received crisis intervention at least once in the previous 2 years for a relapse, and (4) have an International Classification of Diseases-10 diagnosis of a schizophrenia-related disorder. Service users will also be invited to nominate a carer to participate. We will identify the feasibility of the main trial in terms of recruitment and retention to the study and the acceptability, usability, safety, and outcome signals of the EMPOWER intervention. EMPOWER is a mobile phone app that enables the monitoring of well-being and possible EWSs of relapse on a daily basis. An algorithm calculates changes in well-being based on participants’ own baseline to enable tailoring of well-being messaging and clinical triage of possible EWSs. Use of the app is blended with ongoing peer support. ecruitment to the trial began September 2018, and follow-up of participants was completed in July 2019. Data collection is continuing. The database was locked in July 2019, followed by analysis and disclosing of group allocation. he knowledge gained from the study will inform the design of a definitive trial including finalizing the delivery of our digital health intervention, s le size estimation, methods to ensure successful identification, consent, randomization, and follow-up of participants, and the primary and secondary outcomes. The trial will also inform the final health economic model to be applied in the main trial. nternational Standard Randomized Controlled Trial Number (ISRCTN): 99559262 isrctn.com/ISRCTN99559262
Commentary: The Schizophrenia Prodrome: A High-Risk Concept
Publisher: Oxford University Press (OUP)
Date: 2003
Risk, Disorder and Diagnosis
Publisher: SAGE Publications
Date: 11-2011
Outcomes of non-transitioned cases in a sample at ultra-high risk for psychosis
Publisher: American Psychiatric Association Publishing
Date: 03-2015
DOI: 10.1176/APPI.AJP.2014.13030418
Abstract: Two-thirds of in iduals identified as at ultra-high risk for psychosis do not develop psychotic disorder over the medium term. The authors examined outcomes in a group of such patients. Participants were help-seeking in iduals identified as being at ultra-high risk for psychosis 2-14 years previously. The 226 participants (125 female, 101 male) completed a follow-up assessment and had not developed psychosis. Their mean age at follow-up was 25.5 years (SD=4.8). At follow-up, 28% of the participants reported attenuated psychotic symptoms. Over the follow-up period, 68% experienced nonpsychotic disorders: mood disorder in 49%, anxiety disorder in 35%, and substance use disorder in 29%. For the majority (90%), nonpsychotic disorder was present at baseline, and it persisted for 52% of them. During follow-up, 26% of the cohort had remission of a disorder, but 38% developed a new disorder. Only 7% did not experience any disorder at baseline or during follow up. The incidence of nonpsychotic disorder was associated with more negative symptoms at baseline. Female participants experienced higher rates of persistent or recurrent disorder. Meeting criteria for brief limited intermittent psychotic symptoms at intake was associated with lower risk for persistent or recurrent disorder. In iduals at ultra-high risk for psychosis who do not transition to psychosis are at significant risk for continued attenuated psychotic symptoms, persistent or recurrent disorders, and incident disorders. Findings have implications for ongoing clinical care.
Neuropsychological functioning in young people at high-risk for psychosis
Publisher: Elsevier BV
Date: 03-2003
Validity of the 12-item General Health Questionnaire (GHQ-12) in detecting depressive and anxiety disorders among high school students
Publisher: Elsevier BV
Date: 05-2011
DOI: 10.1016/J.PSYCHRES.2010.10.010
Abstract: Despite the common use of the 12-item General Health Questionnaire (GHQ-12) with adolescents, there is limited data supporting its validity with this population. The aims of the study were to investigate the psychometric properties of the GHQ-12 among high school students, to validate the GHQ-12 against the gold standard of a diagnostic interview, and to suggest a threshold score for detecting depressive and anxiety disorders. Six hundred and fifty-four high school students from years 10 to 12 (ages 15-18) completed the GHQ-12 (Likert scored) and the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-IV-Test Revision (DSM-IV-TR). Receiver operating characteristic (ROC) curves were plotted. The mean GHQ-12 score for the total s le was 9.9 (S.D.=5.4). Results from the ROC curve indicated that the GHQ-12 performed better than chance at identifying depressive and anxiety disorders (area under the curve (AUC)=0.781). A GHQ-12 threshold score of 9/10 for males and 10/11 for females was found to be optimal. Given the significant proportion of mental illness among high school students, there may be a need to introduce screening for mental illnesses as part of the school curriculum. This can assist with the early identification and enable low stigma preventive intervention within the school environment.
Left medial temporal volume reduction occurs during the transition from high-risk to first-episode psychosis [See poster session A199]
Publisher: Elsevier BV
Date: 2000
Psychotic-like experiences as overdetermined phenomena: When do they Increase risk for psychotic disorder?
Publisher: Elsevier BV
Date: 03-2009
Prevalence of large cavum septi pellucidi in ultra high-risk individuals and patients with psychotic disorders
Publisher: Elsevier BV
Date: 10-2008
DOI: 10.1016/J.SCHRES.2008.06.021
Abstract: An increased prevalence of large cavum septum pellucidum (CSP), a marker of midline neurodevelopmental abnormality, has been reported in schizophrenia. However, not all studies have been able to replicate this finding and very few studies have been conducted in large s les. In the current study, magnetic resonance imaging was used to assess the presence of an abnormal CSP in 162 patients with first-episode psychosis (FEP), 89 patients with chronic schizophrenia, 135 ultra high-risk (UHR) in iduals, and 87 controls. The prevalence of a large CSP (>5.6 mm) did not differ between the groups (9.3% of the FEP patients, 11.2% of the chronic schizophrenia patients, 11.1% of the UHR in iduals, and 11.5% of the controls). The length of the CSP was not associated with sulcal morphology of the anterior cingulate cortex (ACC), suggesting different biological processes responsible for the CSP enlargement versus ACC folding. These findings suggest that the CSP is not a neurodevelopmental marker of psychosis and cast doubt over the notion that it plays a major role in the neurobiology of psychosis.
Hippocampal and anterior cingulate morphology in subjects at ultra-high-risk for psychosis: The role of family history of psychotic illness
Publisher: Elsevier BV
Date: 06-2005
DOI: 10.1016/J.SCHRES.2004.10.008
Abstract: While structural brain imaging abnormalities have been identified in schizophrenia and related disorders, it is unclear when they arise. Some appear to predate the illness and may be genetic in origin, while others are associated with the onset of the disorder. We examined the hippoc al volumes and anterior cingulate morphology from the MRI scans of 79 male subjects at ultra-high-risk (UHR) for developing psychosis, 35 of whom had a family history of schizophrenia, and compared them with 49 healthy male volunteers. Analysis of covariance demonstrated that left hippoc al volumes were significantly smaller in the UHR group without a family history of schizophrenia, when compared to the UHR group with such history. A similar pattern was found for the left anterior cingulate region, both in terms of reduced paracingulate folding and cingulate sulcus interruptions, although this did not reach significance. We found that a family history of schizophrenia was not associated with a greater degree of structural brain abnormalities in an ultra-high-risk group, and in fact it was those UHR patients without such history who displayed greater abnormalities, although this only reached significance for the left hippoc us. Thus, it appears that the mechanisms that result in gross morphological anomalies in the hippoc us and anterior cingulate in psychosis are driven more by environmental than genetic factors.
Association Between Muscular Strength and Cognition in People With Major Depression or Bipolar Disorder and Healthy Controls
Publisher: American Medical Association (AMA)
Date: 07-2018
Young people at ultra high risk for psychosis: Research from the PACE clinic | Jovens em risco ultra alto de psicose: Pesquisa na clínica PACE
Publisher: EDITORA SCIENTIFIC
Date: 10-2011
DOI: 10.1590/S1516-44462011000600003
Abstract: Over the last fifteen years, attempts have been made to prospectively identify in iduals in the prodromal phase of schizophrenia and other psychotic disorders. The ultra high risk approach, based on a combination of known trait and state risk factors, has been the main strategy used. The validation of the ultra high risk criteria allowed for predictive research in this population in an attempt to identify clinical, neurocognitive and neurobiological risk factors for psychosis onset. It also led to a series of intervention studies in this population, which have included the use of low dose antipsychotic medication, cognitive therapy, and omega-3 fatty acids. Although there is moderate evidence for the effectiveness of specific intervention strategies in this population, the most effective type and duration of intervention is yet to be determined. A current controversy in the field is whether to include an adaption of the ultra high risk criteria (the attenuated psychosis syndrome) in the next version of the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition).
Are UHR patients who present with hallucinations alone at lower risk of transition to psychosis?
Publisher: Elsevier BV
Date: 2016
DOI: 10.1016/J.PSYCHRES.2015.05.085
Abstract: The aim of this study was to investigate whether Ultra High Risk for psychosis (UHR) patients who present with hallucinations alone at identification as UHR are at lower risk of transition to psychosis than UHR patients who present with symptoms other than hallucinations or hallucinations plus other symptoms. Our primary dataset was a retrospective "case-control" study of UHR patients (N=118). The second, independent dataset was a long-term longitudinal follow up study of UHR patients (N=416). We performed a survival analysis using Log-rank test and Cox regression to investigate the relationship between symptom variables and transition to a psychotic disorder. Hallucinations alone at baseline were not significantly associated with a reduced risk of transition to psychosis. In the case control study the presence of hallucinations when found in the absence of any thought disorder and visual hallucinations in the absence of substance misuse was associated with a reduced risk of transition to psychosis. In the longitudinal follow-up dataset perceptual disturbance found in the absence of a disorder of affect or emotion was associated with an increased risk of transition to psychosis.
Prediction and prevention of transition to psychosis in young people at incipient risk for schizophrenia
Publisher: Wiley
Date: 07-10-2002
DOI: 10.1002/AJMG.B.10790
Abstract: The treatment of psychotic disorders, particularly schizophrenia, had been viewed with pessimism until a recent shift in focus from established or chronic illness to earlier phases of illness around the onset highlighted opportunities for enhanced recovery. Associated with this change in focus of research and clinical efforts has been the recognition that the biological and social changes underpinning the development of psychotic disorders may already be active in the pre-psychotic or prodromal phase. It has therefore been suggested that efforts toward the prevention of psychotic disorders should focus on the emerging illness. This article provides a review of work that has been conducted at the PACE Clinic in Melbourne, Australia since 1994. This clinical research program was established to develop strategies for the identification of young people at high risk of developing a psychotic disorder within a short period of time- primarily by virtue of recent mental state changes. Additionally, biological and psychological processes that have been proposed to underlie the development of illness have been investigated and potential preventive interventions have been evaluated.
Early-onset of symptoms predicts conversion to non-affective psychosis in ultra-high risk individuals
Publisher: Elsevier BV
Date: 05-2006
DOI: 10.1016/J.SCHRES.2006.02.018
Abstract: We examined if age of onset of psychiatric symptoms and/or sex predict conversion to non-affective or affective psychosis in in iduals considered to be at ultra-high risk for schizophrenia. Participants (n=86) were offered treatment and monthly follow-up until transition to psychosis, or for 12 months if they did not meet exit criteria for psychotic disorder. In iduals without transition to psychosis at 12-month were reassessed approximately 3 years after the end of the treatment phase. Ultra-high risk was defined by the presence of subthreshold and/or self-limiting psychotic symptoms and/or having a family history of psychotic disorder combined with functional decline. Cox regressions after adjustment for treatment interventions were applied to investigate associations between age of onset, sex, and other baseline measures with progression to psychotic outcomes. Early age of onset of psychiatric symptoms, in particular onset before age 18 was the only tested variable that significantly predicted non-affective psychosis. Independent significant predictors of affective psychosis were poor functioning, female sex and the presence of a combination of intake criteria (family history of psychosis plus drop in functioning, and attenuated and/or brief limited psychotic symptoms) at baseline. Age of onset of psychiatric symptoms is the single most important factor associated with conversion to non-affective psychosis in ultra-high risk in iduals.
Poster #197 FACTOR STRUCTURE OF SCHIZOTYPY AND ASSOCIATIONS WITH PSYCHOPATHOLOGY AND FUNCTIONING IN A GROUP PREVIOUSLY AT ULTRA-HIGH RISK FOR PSYCHOSIS
Publisher: Elsevier BV
Date: 04-2012
The 'close-in' or ultra high risk model: A safe and effective strategy for research and clinical intervention in prepsycxhotic mental disorder
Publisher: Oxford University Press (OUP)
Date: 2003
DOI: 10.1093/OXFORDJOURNALS.SCHBUL.A007046
Abstract: The development of a new frontier for research and early intervention in psychotic disorders is highly dependent on the construction of synergistic clinical infrastructures. This has catalyzed great progress in the recognition, enhanced treatment, and study of first episode psychosis, and the task is even more challenging when the boundaries are extended to include the earliest clinical phase of illness, the prodromal or prepsychotic phase. This article describes the conceptual and practical building blocks for the construction of service models for intervention in the postonset clinical phase prior to the attainment of current diagnostic thresholds. This is best regarded as indicated prevention, a form of very early secondary prevention, which involves a blend of immediate clinical care combined with research-oriented preventive intervention. The experience of the Personal Assessment and Crisis Evaluation (PACE) Clinic in Melbourne across several stages of growth is described and contrasted with that of several emerging centers in Europe and North America. The progress to date, the lessons learned, and the unresolved challenges and opportunities are detailed. It is concluded that service models can be developed that are acceptable and helpful to young people and their families, and that create a unique environment for the study of the transition to frank psychotic disorder. The ultimate clinical utility and general safety of this approach and the range of effective treatments remain unclear, and will be determined by more extensive research. Such research must be conducted in a logical and rigorous manner with the best designs possible, sensitive to input from consumers and caregivers and to ethical considerations.
Proton magnetic resonance spectroscopy in first episode psychosis and ultra high-risk individuals
Publisher: Oxford University Press (OUP)
Date: 2003
DOI: 10.1093/OXFORDJOURNALS.SCHBUL.A007049
Abstract: The underlying neurobiology of emerging psychotic disorders is not well understood. Recent neuroimaging findings have suggested that some brain areas are affected prior to the onset of psychosis, while changes occur in other brain regions during the transition to illness. Further, previous research using magnetic resonance spectroscopy (MRS) has generally demonstrated that there are changes to the brain chemistry of patients with schizophrenia. However, it is unclear whether these changes are present prior to or at the onset of the disorder, and to what extent they are specific to schizophrenia. In this study, we assessed the left medial temporal and left dorsolateral prefrontal regions of 56 patients in their first episode of a psychotic disorder, 30 young people at ultra high-risk (UHR) of developing psychosis, and 21 healthy controls, using proton MRS. Six of the UHR group developed a first episode psychosis over the study period. No differences were identified between the first episode and control groups for any metabolite ratio in either region of interest. This may reflect intact neuronal circuits in the early phase of psychotic disorders. There were also no differences between the UHR and control groups for the medial temporal region. However, there was a significant elevation of the NAA/Creatine and the Choline/Creatine ratios in the dorsolateral prefrontal region of the UHR group, which was interpreted as a decline in creatine indicative of hypometabolism. This finding did not discriminate between those UHR in iduals who later became psychotic and those who did not.
Effects of drop‐out on efficacy estimates in five Cochrane reviews of popular antipsychotics for schizophrenia
Publisher: Wiley
Date: 06-04-2012
DOI: 10.1111/J.1600-0447.2012.01858.X
Abstract: Our aim was to find out how Cochrane reviews of five popular or frequently prescribed second-generation antipsychotics in the UK (olanzapine, risperidone, quetiapine, amisulpride and aripiprazole) approached the problem of high drop-out in placebo-controlled trials. We examined the following: (i) whether reviews included data from studies with a level of drop-out exceeding their stated exclusion criterion (ii) the level of missing data each efficacy outcome in each review relied upon and (iii) impact of excluding studies with high drop-out. All reviews included data they stated they would exclude because of unacceptable levels of attrition, four (risperidone, olanzapine, amisulpride, aripiprazole) without clear acknowledgement or justification. Several reviews also excluded data from a number of relatively low-attrition studies because of missing standard deviations. Cochrane reviews of five popular antipsychotics for schizophrenia misrepresented the available evidence on their efficacy. The impact of including high-attrition studies was difficult to quantify because of the exclusion of relevant low-attrition studies. Further analysis of the efficacy of these drugs in studies with acceptable rates of attrition is required. To reduce the problem of high attrition, trialists should gather follow-up data from people who leave the double-blind process early.
First episode research
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 1998
Psychotic-like experiences in nonpsychotic help-seekers: Associations with distress, depression, and disability
Publisher: Oxford University Press (OUP)
Date: 27-10-2006
Identification of young people at risk of psychosis: validation of Personal Assessment and Crisis Evaluation Clinic intake criteria
Publisher: SAGE Publications
Date: 11-2000
A review of economic evaluations of health care for people at risk of psychosis and for first-episode psychosis
Publisher: Springer Science and Business Media LLC
Date: 17-02-2022
DOI: 10.1186/S12888-022-03769-7
Abstract: Preventing psychotic disorders and effective treatment in first-episode psychosis are key priorities for the National Institute for Health and Care Excellence. This review assessed the evidence base for the cost-effectiveness of health and social care interventions for people at risk of psychosis and for first-episode psychosis. Electronic searches were conducted using the PsycINFO, MEDLINE and Embase databases to identify relevant published full economic evaluations published before August 2020. Full-text English-language studies reporting a full economic evaluation of a health or social care intervention aiming to reduce or prevent symptoms in people at risk of psychosis or experiencing first-episode psychosis were included. Screening, data extraction, and critical appraisal were performed using pre-specified criteria and forms based on the NHS Economic Evaluation Database (EED) handbook and Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist for economic evaluations. The protocol was registered on the PROSPERO database (CRD42018108226). Results were summarised qualitatively. Searching identified 1,628 citations (1,326 following the removal of duplications). After two stages of screening 14 studies met the inclusion criteria and were included in the review. Interventions were varied and included multidisciplinary care, antipsychotic medication, psychological therapy, and assertive outreach. Evidence was limited in the at-risk group with only four identified studies, though all interventions were found to be cost-effective with a high probability ( 80%). A more substantial evidence base was identified for first-episode psychosis (11 studies), with a focus on early intervention (7/11 studies) which again had positive conclusions though with greater uncertainty. Study findings generally concluded interventions were cost-effective. The evidence for the population who are at-risk of psychosis was limited, and though there were more studies for the population with first-episode psychosis, limitations of the evidence base (including generalisability and heterogeneity across the methods used) affect the certainty of conclusions.
Self reported rates of criminal offending and victimization in young people at-risk for psychosis
Publisher: Elsevier BV
Date: 08-2015
DOI: 10.1016/J.SCHRES.2015.05.024
Abstract: A significant relationship exists between experiencing psychosis and both engaging in criminal offending and being a victim of crime. A substantial proportion of violence and offending occurs during the first episode of psychosis, but it is unclear whether such behaviour is also evident in the earlier pre-psychotic stage of illness. As part of a prospective study of young people who were seeking help for mental health problems, we enquired about participants' experiences of being charged and/or convicted of a criminal offence and being a victim of crime. This paper uses cross-sectional baseline data to compare the rates of these forensic outcomes in participants at-risk of psychosis (n=271) with those not at-risk (n=440). Univariate logistic regression showed that the at-risk for psychosis group was significantly more likely than the not at-risk participants to report having been charged by police (11.1% vs 5.9% p=.015) and convicted by the courts (4.4% vs. 1.6% p=0.028) with a non-violent offence, as well as to have been convicted of any criminal offence (6.3% vs. 3.0% p=0.037). The at-risk were also more likely to report having been a victim of crime (23.7% vs 14.0% p=.002), particularly violent victimization (16.5% vs 8.2% p=.001). In multivariate logistic regression analyses, being at-risk for psychosis remained a significant predictor of three of the four outcome measures after controlling for other known covariates such as gender, age, substance misuse and unemployment. This is the first study to demonstrate that, relative to their non-psychotic help-seeking counterparts, young people at-risk for psychosis are at higher risk of forensic outcomes, particularly violent crime victimization.
T2 RELAXOMETRY DETECTS TEMPORAL LOBE PATHOLOGY IN PEOPLE AT ULTRA-HIGH RISK FOR PSYCHOSIS
Publisher: Elsevier BV
Date: 06-2008
Precursors of schizophrenia
Publisher: Springer Science and Business Media LLC
Date: 06-2004
Randomized controlled trial of interventions designed to reduce the risk of progression to first-episode psychosis in a clinical sample with subthreshold symptoms
Publisher: American Medical Association (AMA)
Date: 10-2002
DOI: 10.1001/ARCHPSYC.59.10.921
Abstract: Most disability produced by psychotic illnesses, especially schizophrenia, develops during the prepsychotic period, creating a case for intervention during this period. However, only recently has it been possible to engage people in treatment during this phase. A randomized controlled trial compared 2 interventions in 59 patients at incipient risk of progression to first-episode psychosis. We termed this group ultra-high risk to emphasize the enhanced risk vs conventional genetic high-risk studies. Needs-based intervention was compared with specific preventive intervention comprising low-dose risperidone therapy (mean dosage, 1.3 mg/d) and cognitive behavior therapy. Treatment was provided for 6 months, after which all patients were offered ongoing needs-based intervention. Assessments were performed at baseline, 6 months, and 12 months. By the end of treatment, 10 of 28 people who received needs-based intervention progressed to first-episode psychosis vs 3 of 31 from the specific preventive intervention group (P=.03). After 6-month follow-up, another 3 people in the specific preventive intervention group became psychotic, and with intention-to-treat analysis, the difference was no longer significant (P=.24). However, for risperidone therapy-adherent patients in the specific preventive intervention group, protection against progression extended for 6 months after cessation of risperidone use. More specific pharmacotherapy and psychotherapy reduces the risk of early transition to psychosis in young people at ultra-high risk, although their relative contributions could not be determined. This represents at least delay in onset (prevalence reduction), and possibly some reduction in incidence.
Making Early Intervention more equitable
Publisher: SAGE Publications
Date: 22-03-2017
Is pre-psychotic intervention realistic in schizophrenia and related disorders?
Publisher: SAGE Publications
Date: 12-1997
DOI: 10.3109/00048679709065502
Abstract: Objective: The aim of this paper is to discuss the logistic and ethical questions related to the possibility of intervention prior to the onset of first-episode psychosis (i.e. during the prodromal phase). Method: The method involved examination of the published literature on prevention of psychotic disorders and other mental disorders, and critical evaluation of current practice in treating pre-psychotic in iduals. Results: Issues of possibly unnecessary or premature labelling, stigma and treatment arise. The question of whether such early intervention merely diagnoses the disorder earlier but does not actually improve outcome is also discussed, as are the economic implications of shifting emphasis from treatment of established disorders to preventive interventions. Conclusions: There are many legitimate concerns related to intervening in pre-psychotic in iduals which must be understood by those involved in planning preventive interventions. Policies should be developed incorporating some of the ethical and economic concerns, and these need to be evaluated and changed in response to ongoing research. However, these issues need not stand in the way of the development of innovative preventive approaches to the treatment of schizophrenia and other psychotic disorders.
PREVENTING A FIRST EPISODE OF PSYCHOSIS: A META-ANALYSIS
Publisher: Elsevier BV
Date: 04-2014
Early intervention in psychosis: An overdue reform
Publisher: SAGE Publications
Date: 08-2003
DOI: 10.1046/J.1440-1614.2003.01192.X
Abstract: Objective: To discuss the rationale for early intervention in psychotic disorders and to explore why the widespread implementation of early intervention services has stalled. Method: Four central questions are explored regarding early intervention in psychosis: (i) what is the rationale for early intervention services in psychosis and is it justified? (ii) what are the obstacles to the implementation of early intervention services throughout Australia? (iii) how could some of these obstacles be overcome? and (iv) what else needs to occur? Results: Early intervention in psychosis aims to improve recognition and access, promote recovery from the initial psychotic episode, minimize secondary morbidity and reduce collateral damage. It may also prevent some brain dysfunction and damage, which may otherwise occur later in the illness. Despite the now growing body of evidence supporting the idea of early intervention, obstacles remain to its widespread adoption in policy and implementation, principally related to chronic under-funding of the public mental health system. Among the solutions proposed is the need to develop services with a youth focus, able to cater for young people with both psychotic and non-psychotic psychiatric disorders. These services should be well integrated with primary care and other youth orientated agencies. Conclusions: We are hopeful that strong investment in early intervention and better services for young people will be among the highest priorities of the Third National Mental Health Plan. This is not only where the greatest public health burden lies, but also where costeffectiveness of intervention is likely to be maximal.
Transitions Study of predictors of illness progression in young people with mental ill health: study methodology
Publisher: Wiley
Date: 24-07-2015
DOI: 10.1111/EIP.12079
Abstract: An estimated 75% of mental disorders begin before the age of 24 and approximately 25% of 13-24-year-olds are affected by mental disorders at any one time. To better understand and ideally prevent the onset of post-pubertal mental disorders, a clinical staging model has been proposed that provides a longitudinal perspective of illness development. This heuristic model takes account of the differential effects of both genetic and environmental risk factors, as well as markers relevant to the stage of illness, course or prognosis. The aim of the Transitions Study is to test empirically the assumptions that underpin the clinical staging model. Additionally, it will permit investigation of a range of psychological, social and genetic markers in terms of their capacity to define current clinical stage or predict transition from less severe or enduring to more severe and persistent stages of mental disorder. This paper describes the study methodology, which involves a longitudinal cohort design implemented within four headspace youth mental health services in Australia. Participants are young people aged 12-25 years who have sought help at headspace and consented to complete a comprehensive assessment of clinical state and psychosocial risk factors. A total of 802 young people (66% female) completed baseline assessments. Annual follow-up assessments have commenced. The results of this study may have implications for the way mental disorders are diagnosed and treated, and progress our understanding of the pathophysiologies of complex mental disorders by identifying genetic or psychosocial markers of illness stage or progression.
Identifying the ultra-high risk (prodromal) population: Evaluation of training workshops with mental health services
Publisher: SAGE Publications
Date: 2008
DOI: 10.1080/00048670701827630
Abstract: Objective: Recent years have witnessed widespread interest in the early phase of psychotic disorders. The most widely used approach to identify in iduals in the prodromal phase is the ultra-high risk (UHR) approach, which combines known trait and state risk factors for psychotic disorder. The Personal Assessment and Crisis Evaluvation Clinic introduced the Comprehensive Assessment of At Risk Mental States (CAARMS) in order to assess UHR status. A training DVD and manual in the use of the CAARMS was recently developed in order to assist with UHR identification. The current paper reports the outcome of a series of training workshops with mental health professionals based around this DVD. The research aim was to investigate whether the training workshops assisted mental health professionals in their confidence and ability to accurately identify UHR cases and distinguish these from non-UHR and first-episode psychosis (FEP) cases. Method: A total of 137 mental health workers participated in the training sessions across eight training sites. The training sessions consisted of four modules: theoretical background rating written vignettes for UHR, non-UHR or FEP status viewing and discussing the CAARMS Training DVD and re-rating matched written vignettes for UHR, non-UHR or FEP status. Results: Participants’ confidence in identifying UHR cases and in using the CAARMS increased as a result of the workshop. Participants’ ability to correctly identify UHR-positive cases did not improve as a result of the workshop. This may have been the result of a ceiling effect due to the baseline ability to identify UHR-positive cases being high. But there was a trend for participants’ ability to correctly identify UHR-negative cases to improve as a result of the workshop. Conclusions: UHR training workshops are a valuable means of increasing mental health workers’ confidence in identifying UHR patients. Future UHR training programmes with experienced mental health professionals should pay particular attention to the correct identification of UHR-negative cases.
Cyclin-dependent Kinase E1 (CDKE1) Provides a Cellular Switch in Plants between Growth and Stress Responses
Publisher: Elsevier BV
Date: 02-2013
Brain changes during the onset of schizophrenia: implications for neurodevelopmental theories
Publisher: AMPCo
Date: 02-2009
DOI: 10.5694/J.1326-5377.2009.TB02367.X
Abstract: Neuroimaging studies of in iduals at risk of psychosis have the potential to identify markers predictive of illness onset and features that progress with transition. To date, reduced brain volumes have shown weak predictive value for onset of psychotic illness. All published longitudinal studies of the transition to psychosis show progressive brain changes that are not seen in at-risk in iduals who do not develop the disorder. Although the cause of these changes is unclear, they challenge the conventional neurodevelopmental model of schizophrenia.
Clinical Staging: A Heuristic and Practical Strategy for New Research and Better Health and Social Outcomes for Psychotic and Related Mood Disorders
Publisher: SAGE Publications
Date: 08-2010
DOI: 10.1177/070674371005500803
Abstract: Most mental illnesses emerge during adolescence and early adulthood, with considerable associated distress and functional decline appearing during this critical developmental phase. Our current diagnostic system lacks therapeutic validity, particularly for the early stages of mental disorders when symptoms are still emerging and intensifying and have not yet stabilized sufficiently to fit the existing syndromal criteria. While this is, in part, due to the difficulty of distinguishing transient developmental or normative changes from the early symptoms of persistent and disabling mental illness, these factors have contributed to a growing movement for the reform of our current diagnostic system to more adequately inform the choice of therapeutic strategy, particularly in the early stages of a mental illness. The clinical staging model, which defines not only the extent of progression of a disorder at a particular point in time but also where a person lies currently along the continuum of the course of an illness, is particularly useful as it differentiates early, milder clinical phenomena from those that accompany illness progression and chronicity. This will not only enable clinicians to select treatments relevant to earlier stages of an illness, where such interventions are likely to be more effective and less harmful than treatments delivered later in the course of illness, but also allow a more efficient integration of our rapidly expanding knowledge of the biological, social, and psychological vulnerability factors involved in the development of mental illness into a useful diagnostic framework.
'At-risk' for psychosis research: Where are we heading?
Publisher: Cambridge University Press (CUP)
Date: 30-07-2012
DOI: 10.1017/S2045796012000388
Abstract: The ‘at-risk’ criteria are a useful paradigm for investigating the psychological, neurocognitive, neurobiological and genetic risk factors for psychosis, specifically schizophrenia. To date, the primary outcome of interest in at-risk research has been the development of psychotic disorder, whereby patients are categorized as either having ‘transitioned’ or ‘not transitioned’. Despite the acceptance of this dichotomy, it is important to consider that the threshold at which psychotic symptoms progress from attenuated to frank ‘psychotic disorder’ is arbitrary and may be incorrect or meaningless in terms of neurobiological and functional changes associated with psychosis. This has implications for clinical care and the search for markers of schizophrenia. We present recent research suggesting that the term ‘outcome’ needs to be broadened to incorporate non-psychotic diagnoses, functioning and negative symptoms. Shifting the traditional notion of outcome is the future challenge for at-risk research, but the inclusion of outcomes other than psychosis is likely to result in better aetiological models of psychotic illness.
The Comprehensive Assessment of At-Risk Mental States: From mapping the onset to mapping the structure
Publisher: Elsevier BV
Date: 04-2011
DOI: 10.1016/J.SCHRES.2010.12.021
Abstract: Improving the identification of clinical vulnerability to psychosis in help-seeking subjects is crucial for refining risk stratifications and implementing intervention strategies. To define underlying dimensions of subclinical psychopathology in Ultra-High-Risk (UHR) subjects to test their temporal stability and association with baseline clinical and functional features and to evaluate their predictive value for subsequent transition to psychosis. 223 subjects meeting the Personal Assessment and Crisis Evaluation (PACE) criteria for UHR were assessed with the Comprehensive Assessment of At-Risk Mental States (CAARMS) and monitored for a period of up to three years. Data were analysed via principal component analysis (PCA), Spearman correlation analysis and Cox regression. PCA of the CAARMS yielded three orthogonal symptom clusters (negative, disorganized and perceptual-affective instability) with substantial temporal stability over a one-month time span. These clusters were strongly related to global functioning, quality of life, baseline major psychopathology and duration of symptoms before referral. The severity of the CAARMS disorganized component was the strongest predictor of transition to frank psychosis at follow-up. A dimensional approach to CAARMS-measured symptoms may refine current early identification heuristics and provide an alternative way to characterize UHR profiles complementary to the current categorical one.
Reduced parahippocampal cortical thickness in subjects at ultra-high risk for psychosis
Publisher: Cambridge University Press (CUP)
Date: 10-05-2013
DOI: 10.1017/S0033291713000998
Abstract: Grey matter volume and cortical thickness represent two complementary aspects of brain structure. Several studies have described reductions in grey matter volume in people at ultra-high risk (UHR) of psychosis however, little is known about cortical thickness in this group. The aim of the present study was to investigate cortical thickness alterations in UHR subjects and compare in iduals who subsequently did and did not develop psychosis. We examined magnetic resonance imaging data collected at four different scanning sites. The UHR subjects were followed up for at least 2 years. Subsequent to scanning, 50 UHR subjects developed psychosis and 117 did not. Cortical thickness was examined in regions previously identified as sites of neuroanatomical alterations in UHR subjects, using voxel-based cortical thickness. At baseline UHR subjects, compared with controls, showed reduced cortical thickness in the right parahippoc al gyrus ( p 0.05, familywise error corrected). There were no significant differences in cortical thickness between the UHR subjects who later developed psychosis and those who did not. These data suggest that UHR symptomatology is characterized by alterations in the thickness of the medial temporal cortex. We did not find evidence that the later progression to psychosis was linked to additional alterations in cortical thickness, although we cannot exclude the possibility that the study lacked sufficient power to detect such differences.
Cost implications of specific and non-specific treatment for young persons at ultra high risk of developing a first episode of psychosis
Publisher: Wiley
Date: 02-2009
DOI: 10.1111/J.1751-7893.2008.00106.X
Abstract: Costs associated with mental health treatment for young persons at 'ultra' high risk (UHR) of developing a psychotic disorder have not previously been reported. This paper reports cost implications of providing psychological and pharmacological intervention for in iduals at UHR for psychosis compared with minimal psychological treatment. Mental health service costs associated with a randomized controlled trial of two treatments (Specific Preventive Intervention: SPI and Needs-Based Intervention: NBI) for UHR young persons were estimated and compared at three time points: treatment phase, short-term follow up and medium-term follow up. Although the SPI group incurred significantly higher treatment costs than the NBI group over the treatment phase, they incurred significantly lower outpatient treatment costs over the longer term. This study indicates that specific interventions designed to treat young persons who are identified as being at UHR of psychosis might be associated with some cost savings compared with non-specific interventions.
Poster #55 T2 RELAXATION TIMES IN THE SUPERIOR TEMPORAL GYRUS OF INDIVIDUALS AT ULTRA-HIGH RISK FOR PSYCHOSIS AND THEIR ASSOCIATION WITH AUDITORY HALLUCINATIONS
Publisher: Elsevier BV
Date: 04-2012
Measuring psychosocial outcome is good
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2013
At Risk for Schizophrenic or Affective Psychoses? A Meta-Analysis of DSM/ICD Diagnostic Outcomes in Individuals at High Clinical Risk
Publisher: Oxford University Press (OUP)
Date: 15-05-2012
An MRI study of subjects in the prodromal phase of psychosis
Publisher: Cambridge University Press (CUP)
Date: 05-2002
Prevention and treatment of long-term social disability amongst young people with emerging severe mental illness with social recovery therapy (The PRODIGY Trial): study protocol for a randomised contr
Publisher: Springer Science and Business Media LLC
Date: 11-07-2017
The association between early cannabis use and psychotic-like experiences in a community adolescent sample
Publisher: Elsevier BV
Date: 07-2009
DOI: 10.1016/J.SCHRES.2009.04.001
Abstract: Cannabis use has been associated with greater risk of developing psychotic-like experiences (PLEs) and psychosis. This paper aims to determine if different levels of cannabis (lifetime, regular, recent) exposure are associated with PLEs and specific PLE subscales among adolescents. Participants consisted of a community s le of 880 adolescents in Melbourne, Australia. Adolescents were administered the positive symptom scale of the Community Assessment of Psychic Experiences (CAPE) and measures of substance use and depression. Lifetime cannabis use and the frequency of cannabis use in the last year (recent use) were associated with PLEs, primarily the experience of auditory and visual hallucinations (perceptual abnormalities). Low levels of recent cannabis use were more strongly associated with PLEs than more frequent use. These findings indicate that different levels of cannabis exposure were differentially associated with PLEs and highlight the need for early detection and treatment strategies for PLEs and cannabis use in adolescents.
Limitations and Value of Animal Models of Relevance to the Schizophrenia Prodrome
Publisher: Elsevier BV
Date: 2023
Baseline grey matter volume of non-transitioned ultra high risk for psychosis individuals with and without attenuated psychotic symptoms at long-term follow-up
Publisher: Elsevier BV
Date: 06-2016
DOI: 10.1016/J.SCHRES.2015.05.014
Abstract: Two thirds of in iduals identified as ultra-high risk (UHR) for psychosis do not transition to psychosis over the medium to long-term (non-transition UHR-NT). Nevertheless, many of these in iduals have persistent attenuated psychotic symptoms (APS). The current study examined whether there were differences in baseline grey matter volume (i.e. at initial identification as UHR) in UHR-NT in iduals whom had APS compared to those without APS (No-APS) at medium to long-term follow-up. Participants were help-seeking in iduals who were identified as being at UHR for psychosis between 2 and 12years previously (mean=7.5). The s le consisted of 109 participants who underwent a Magnetic Resonance Imaging scan at baseline and who had not been observed to develop a psychotic disorder over the follow-up period (UHR-NT). Using voxel-based morphometry, baseline grey matter volume (GMV) was compared between participants with (N=30) and without (N=79) APS at follow-up. At baseline, the APS and No-APS groups were clinically indistinguishable. At follow-up, the APS group had significantly worse symptoms and impaired functioning. In iduals with APS had reduced baseline GMV in frontal, temporal, posterior and cingulate regions compared to those without APS at follow-up. Reduced GMV was associated with more severe positive, negative and depressive symptoms and lower global functioning in the combined UHR-NT cohort. These associations were independent of later APS outcome. This study found that differences in regional GMV are discernible at an early stage of UHR and may be specific to in iduals who have APS and psychopathology at follow-up. Our findings suggest that lower GMV at baseline may confer neurobiological risk for later APS and/or increased psychopathology while the absence of these structural abnormalities might be protective.
Sexual Trauma Increases the Risk of Developing Psychosis in an Ultra High-Risk “Prodromal” Population
Publisher: Oxford University Press (OUP)
Date: 02-03-2013
Dr McGorry and Colleagues Reply
Publisher: Physicians Postgraduate Press, Inc
Date: 15-11-2013
Ethics and early intervention in psychosis: keeping up the pace and staying in step
Publisher: Elsevier BV
Date: 08-2001
DOI: 10.1016/S0920-9964(01)00235-3
Abstract: The intense clinical and research interest in early psychosis in recent years has highlighted a range of ethical issues which need to be considered carefully. Our perspective is based on 16 years of clinical and research experience with young people at this phase of illness as well as the research contributions of many others. We discuss the ethical dilemmas in relation to the three key foci, which make up the early psychosis paradigm. These are the pre-psychotic or prodromal phase, the period of untreated psychosis and the first psychotic episode and the critical period of recovery, which follows this. Most attention is devoted to the pre-psychotic period, however ethical considerations related to research in the other two clinical foci are briefly covered as well. Our contention is that the ethical issues are essentially identical to those arising in early intervention research in mainstream medicine. This has been concealed by inconsistency and emotion, which has great potential to confuse, politicize and derail rational debate. The legacy of the isolation of psychiatry from medicine and consequent prejudice and stigma in the professional as well as the public mind seems to be fueling a tendency in some societies to view psychiatric research as qualitatively different from other medical research. Sound clinical research data should be allowed to illuminate the options for potential consumers across all phases of illness. The alternative is research paralysis, which would force clinical practice to expand blindly without an evidence base.
The Dark Side of the Moon: Meta-analytical Impact of Recruitment Strategies on Risk Enrichment in the Clinical High Risk State for Psychosis
Publisher: Oxford University Press (OUP)
Date: 20-11-2015
White matter volume changes in people who develop psychosis
Publisher: Royal College of Psychiatrists
Date: 09-2018
DOI: 10.1192/BJP.BP.107.043463
Abstract: Grey matter changes have been described in in iduals who are pre- and peri-psychotic, but it is unclear if these changes are accompanied by changes in white matter structures. To determine whether changes in white matter occur prior to and with the transition to psychosis in in iduals who are pre-psychotic who had previously demonstrated grey matter reductions in frontotemporal regions. We used magnetic resonance imaging (MRI) to examine regional white matter volume in 75 people with prodromal symptoms. A subset of the original group ( n =21) were rescanned at 12–18 months to determine white matter volume changes. Participants were retrospectively categorised according to whether they had or had not developed psychosis at follow-up. Comparison of the baseline MRI data from these two subgroups revealed that in iduals who later developed psychosis had larger volumes of white matter in the frontal lobe, particularly in the left hemisphere. Longitudinal comparison of data in in iduals who developed psychosis revealed a reduction in white matter volume in the region of the left fronto-occipital fasciculus. Participants who had not developed psychosis showed no reductions in white matter volume but increases in a region subjacent to the right inferior parietal lobule. The reduction in volume of white matter near the left fronto-occipital fasciculus may reflect a change in this tract in association with the onset of frank psychosis.
Characterisation of the prodrome to a first episode of psychotic mania: Results of a retrospective study
Publisher: Elsevier BV
Date: 08-2010
DOI: 10.1016/J.JAD.2009.12.021
Abstract: Little is known about the early phases of bipolar disorders (BPAD) and most of current knowledge derives from putative "high-risk" studies conducted in populations of bipolar off-spring such information may therefore be relevant only to a sub-group of at-risk subjects. Retrospective assessment of the phase preceding the emergence of mania and of premorbid characteristics of patients treated for a first episode of psychotic mania. The collected data was used mainly to generate hypotheses. Before onset of a first episode of psychotic mania, patients go through a phase of change from previous mental state where they present mood symptoms, sleep disruption and general functional decline. These clinical manifestations are however likely to have low specificity. However, their occurrence in patients presenting certain risk factors or markers of vulnerability that were identified at a relatively high prevalence in our s le, may be an indicator of impending first episode mania. This is a retrospective study, in a small s le of patients presenting with psychotic mania. Criteria identified need therefore to be validated in larger prospective studies. Early identification of patients at risk to develop a first episode of psychotic mania is unlikely to be possible on the basis of symptoms alone. However, the occurrence of certain clinical characteristics in patients who have risk factors or markers of vulnerability to BPAD could be a sign of impending first episode mania.
Perceptual organization in first episode schizophrenia and ultra-high-risk states
Publisher: Elsevier BV
Date: 03-2006
DOI: 10.1016/J.SCHRES.2006.01.003
Abstract: Deficits in perceptual organization have been consistently reported in schizophrenia, as has an association between these deficits, disorganized symptoms, and poorer premorbid functioning and prognosis, suggesting that they may be an index of illness severity or progression. It is unclear, however, whether the impairment is present at, or before the first psychotic episode. This study examined perceptual organization in young people considered to be at high-risk for schizophrenia, defined by the "close-in" strategy [Yung, A.R., McGorry, P.D., McFarlane, C.A., Jackson, H.J., Patton, G.C., Rakkar, 1996. Monitoring and care of young people at incipient risk of psychosis. Schizophrenia Bulletin, 22, 283-303]. The high-risk group (n=70) was compared to first-episode patients (n=54), and nonpatients (n=24) using a task with known sensitivity to perceptual organization deficits in schizophrenia, and whose scores have predicted long-term outcome and disorganized symptomatology in past studies [Knight, R.A., Silverstein, S.M., 1998. The role of cognitive psychology in guiding research on cognitive deficits in schizophrenia. In Lenzenweger, M., Dworkin, R.H., (Eds.), Origins and Development of Schizophrenia: Advances in Experimental Psychopathology. APA Press, Washington DC, pp. 247-295. Silverstein, S.M., Knight, R.A., Schwarzkopf, S.B., West, L.L., Osborn, L.M. Kamin, D., 1996b. Stimulus configuration and context effects in perceptual organization in schizophrenia. Journal of Abnormal Psychology 105, 410-420. Silverstein, S.M., Schenkel, L.S., Valone, C., Nuernberger, S., 1998a. Cognitive deficits and psychiatric rehabilitation outcomes in schizophrenia. Psychiatric Quarterly 69, 169-191. Silverstein, S.M., Bakshi, S., Chapman, R.M., Nowlis, G., 1998b. Perceptual organization of configural and nonconfigural visual patterns in schizophrenia: effects of repeated exposure. Cognitive Neuropsychiatry 3, 209-223]. There were no differences between groups, and the first-episode group demonstrated non-significantly more sensitivity to stimulus organization than the other groups. When the high-risk group was broken down into its 3 subgroups (A--family history of psychotic illness and recent drop of 30+ points in the GAF scale B--history of attenuated psychotic symptoms C--brief limited intermittent psychotic symptoms), only group A demonstrated evidence of impairment, but this group differed significantly only from first- and young, later-episode schizophrenia patients, not from nonpatients. These findings are consistent with recent data on pre-attentive processes in schizophrenia which indicate that performance is not impaired and may even be enhanced, early in the illness, with dysfunctions beginning with increased chronicity.
Randomized Controlled Trial of Interventions for Young People at Ultra-High Risk of Psychosis
Publisher: Physicians Postgraduate Press, Inc
Date: 27-11-2012
DOI: 10.4088/JCP.12M07785
Implementing an innovative intervention to increase research capacity for enhancing early psychosis care in Indonesia
Publisher: Wiley
Date: 11-09-2017
DOI: 10.1111/JPM.12417
Abstract: WHAT IS KNOWN ON THE TOPIC?: In low- and middle-income settings (LMICs) such as Indonesia, the burden from psychotic illness is significant due to large gaps in treatment provision Mental health workers and community nurses are a growing workforce requiring new evidence to support practice and enhanced roles and advanced competencies among UK mental health nurses also requires greater research capacity Research capacity building projects can strengthen research institutions, enhance trial capacity, improve quality standards and improve attitudes towards the importance of health research. WHAT THIS PAPER ADDS?: Delivering innovative, cross-cultural workshops to enhance research capacity to multidisciplinary, early career researchers in Indonesia and the UK are rated highly by attendees Supporting people in this way helps them to gain competitive grant funding to complete their own research which can improve the health of the population To our knowledge, there are no other studies reporting the attainment of grant income as a successful outcome of international research partnerships for mental health nursing so our finding is novel. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: This method could be implemented to improve networking and collaboration between UK academics and early career researchers in other lower- and middle-income settings This strategy can also strengthen existing partnerships among early career researchers in the UK to meet the demands for greater research mentorship and leadership among mental health nurses and enhance nurses capabilities to contribute to evidence for practice. Aim To strengthen research capacity for nurses and early career researchers in Indonesia and the UK to develop a local evidence base in Indonesia to inform policy and improve the nation's health. These strategies can strengthen research institutions, enhance trial capacity, improve quality standards and improve attitudes towards the importance of health research. Methods Four days of workshops were held in Jakarta, Indonesia developing collaborative groups of academic nurses and early career researchers from the UK and Indonesia (30 people including mentors) to produce competitive grant bids to evaluate aspects of early psychosis care. Qualitative and quantitative evaluations were conducted. Results Participants evaluated the workshops positively finding benefit in the structure, content and delivery. Research impact was shown by attaining several successful small and large grants and developing offshoot collaborative relationships. Discussion These novel findings demonstrate that collaborative workshops can strengthen research capacity by developing partnerships and instigating new collaborations and networks. No other studies of international research partnerships among mental health nurses have reported this outcome to our knowledge. Implications for Practice This method could be implemented to improve networking and collaboration between UK academics and early career researchers and also with external colleagues in other LMICs.
More frequent lithium testing in
UK
Primary Care associates with a lower hospital admission rate for bipolar disorder—What this can tell us about
GP
Publisher: Hindawi Limited
Date: 04-2019
DOI: 10.1111/IJCP.13277
Social cognition deficits and the ‘ultra high risk’ for psychosis population: a review of literature
Publisher: Wiley
Date: 04-07-2011
DOI: 10.1111/J.1751-7893.2011.00275.X
Abstract: A number of risk factors for developing a psychotic disorder have been investigated in the 'ultra high risk' (UHR) population, including neurocognitive abilities, social functioning and, more recently, social cognition. We aimed to review the literature on social cognition in the UHR population. Literature was restricted to English articles and identified using Pubmed, Medline, PsychINFO and CINAHLplus, as well as the reference lists of published studies and reviews. Search terms included social cognition, theory of mind, emotion recognition, attributional style, social knowledge, social perception, 'at risk mental state', psychosis prodrome 'clinical high risk' and 'ultra high risk'. Inclusion criteria were an outcome measure of a social cognition task and an UHR population defined by a structured validated instrument. Seven original research articles met the inclusion criteria, one of which was a conference abstract. One of the two studies that assessed theory of mind, two of the four studies that assessed emotion recognition and both the two studies that assessed social perception/knowledge found significant deficits in UHR patients. The single study that assessed attributional bias also reported differences in UHR patients compared with healthy controls. There is limited published literature on social cognitive performance in the UHR population. Despite this, deficits in certain social cognitive abilities do appear to be present, but further research with more reliable cross-cultural measures is needed. The characterization of social cognitive deficits in the UHR populations may aid in the identification of potential markers for development of a subsequent psychotic disorder, as well as targets for early intervention.
Neurobiological findings in early phase schizophrenia
Publisher: Elsevier BV
Date: 03-2000
DOI: 10.1016/S0165-0173(99)00033-8
Abstract: This paper summarises the available information on MRI-determined hippoc al morphometry in first-episode patients as an illustration of the value and interpretation of findings in the neurobiology of early phase schizophrenia. We report a thin slice (1.5 mm) study of 32 first episode and 39 high risk patients which demonstrated significantly smaller hippoc i (right -9%, left -11%) in first episode patients that were of a similar magnitude to those found in chronic patients (right -10%, left -11%) but non-significant volume reductions in high risk in iduals, including the 15 subjects who subsequently developed psychoses. Consideration is given to the implications of these findings, including the possible role of early and later neurodevelopmental influences. We present animal data showing that chronic placental insufficiency, as elicited by uterine artery ligation can give rise to substantial reduction (31%) in hippoc al volumes and reflect on other potentially relevant pathophysiological mechanisms, including those that may occur during the early phases of psychotic illnesses, including their prodromes. Greater attention needs to be paid to the study of early phase psychosis in order to obtain a clearer understanding of the nature and time course of neurobiological changes associated with it. Although there is a growing literature on first episode psychosis, there is a striking dearth of information on the neurobiology of the prodrome.
Ventricle volumes in emerging psychosis. A cross-sectional and longitudinal MRI study
Publisher: Cambridge University Press (CUP)
Date: 03-2007
Distress related to psychotic symptoms in individuals at high risk of psychosis
Publisher: Elsevier BV
Date: 2020
DOI: 10.1016/J.SCHRES.2019.11.027
Abstract: This study assessed the relationship between distress, severity and frequency of attenuated psychotic symptoms in in iduals meeting Ultra High Risk (UHR) criteria, both at baseline and over time. It also assessed distress in relation to attenuated symptoms and whether cognitive behavioural therapy (CBT) reduced distress over time by symptom type. At baseline a combined total of 592 UHR participants (mean age 19.9 males, 53.9%) from two studies were assessed using a confirmatory factor analysis (CFA). Change over time from this baseline point was assessed using latent growth curve (LGC) models, based on participants from one of the studies. Distress associated with psychotic symptom was shown to be a separate psychological construct from severity and frequency. Distress was also significantly associated with severity but not frequency. Longitudinal LGC models with 244 participants showed that distress, severity and frequency all reduced over six months, although the rate of distress reduction varied across symptom type. Non-bizarre ideas (NBI) were more distressing and had the fastest rate of distress reduction over time. The baseline distress for some symptoms also strongly predicted the symptom severity change over time, suggesting that distress may cause change in the UHR criteria for unusual thought content (UTC) and NBI symptoms. CBT was not shown to be significantly different from treatment as usual (TAU) in its effect on distress. However, distress reduces over time, particularly in the first 3 months after presentation. We recommend that distress should be used as an outcome in future research and as a clinical indicator. (250 words).
Diet as a hot topic in psychiatry: a population-scale study of nutritional intake and inflammatory potential in severe mental illness
Publisher: Wiley
Date: 07-09-2018
DOI: 10.1002/WPS.20571
Cannabis use is not associated with the development of psychosis in an 'ultra' high-risk group
Publisher: SAGE Publications
Date: 12-2002
DOI: 10.1046/J.1440-1614.2002.01089.X
Abstract: Background: The association between cannabis use and the development of a first psychotic episode was studied in a group of 100 young people identified as being at very high risk for the onset of psychosis. Method: The ‘ultra’ high risk cohort was identified by the presence of subthreshold psychotic symptoms, or a combination of first-degree relative with a psychotic disorder and recent functional decline. Thirty-two per cent of the cohort developed an acute psychotic episode over the 12-month period after recruitment. As a component of a larger research study, the level of cannabis use by participants in the year prior to enrolment in the study was assessed at intake. Results: Cannabis use or dependence in the year prior to recruitment to this study was not associated with a heightened risk of developing psychosis over the following 12-month period and therefore did not appear to contribute to the onset of a psychotic disorder. Conclusion: The results of this study suggest that cannabis use may not play an integral role in the development of psychosis in a high-risk group. While this study does not support a role for cannabis in the development of first-episode psychosis, we cannot conclude that cannabis use should be completely ignored as a candidate risk factor for onset of psychosis. A number of weaknesses of the study (the low level of cannabis use in the current s le, the lack of monitoring of cannabis use after intake) suggest that it may be premature to dismiss cannabis use as a risk factor for the development of psychosis and further research is urged in this area.
Prevalence of Major Cardiovascular Disease Events Among People Diagnosed With Schizophrenia Who Have Sleep Disturbance, Sedentary Behavior, or Muscular Weakness
Publisher: Oxford University Press (OUP)
Date: 2021
DOI: 10.1093/SCHIZBULLOPEN/SGAA069
Abstract: To estimate prevalence of major cardiovascular events among people with schizophrenia who had experience of sleep disturbance, sedentary behavior or muscular weakness, and assess evidence for raised prevalence in these in iduals compared to people with schizophrenia without these characteristics. UK Biobank data on in iduals diagnosed with schizophrenia (n = 1544) were used to examine the prevalence of major cardiovascular events, specifically myocardial infarction, stroke, heart failure and cardiovascular death, among participants with candidate risk factors. Generalized linear models were fitted to estimate prevalence ratios (PRs) for major cardiovascular events among participants with self-reported sleep disturbance, self-reported sedentary behavior, and muscular weakness measured using a handgrip dynamometer. These ratios were adjusted for QRISK3 score—a validated cardiovascular risk prediction algorithm for the UK population. Prevalence of major cardiovascular events was significantly higher among participants with daytime sleepiness, independent of QRISK3 score, and snoring, a proxy for sleep-disordered breathing (adjusted PR 1.26 95% CI 1.03, 1.55, P = .03). Prevalence was also independently higher among participants with low muscular strength (adjusted PR1.36 95% CI 1.05, 1.75, P = .02). The adjusted prevalence ratios among participants with short or prolonged sleep duration, insomnia, or sedentary behavior did not indicate independently raised prevalence among these groups. Prevalence of major cardiovascular events among people with schizophrenia was higher in participants with muscular weakness and sleep disturbance evidenced by daytime sleepiness. Further research is required to determine how these factors can be routinely identified and addressed in the clinical management of cardiovascular risk among patients with schizophrenia.
Progressive brain structural changes mapped as psychosis develops in 'at risk' individuals
Publisher: Elsevier BV
Date: 03-2009
S.14.02 Transition to psychosis – what happens in the brain?
Publisher: Elsevier BV
Date: 08-2008
Psychotic experiences and their significance
Publisher: Wiley
Date: 06-2016
DOI: 10.1002/WPS.20328
Monitoring of physical health in services for young people at ultra‐high risk of psychosis
Publisher: Wiley
Date: 18-10-2015
DOI: 10.1111/EIP.12288
Youth depression alleviation: the Fish Oil Youth Depression Study (YoDA ‐F): A randomized, double‐blind, placebo‐controlled treatment trial
Publisher: Wiley
Date: 13-08-2014
DOI: 10.1111/EIP.12166
Abstract: US authorities have recommended 'black-box' warnings for antidepressants because of the increased risk of suicidality for in iduals up to age 25. There is thus a clinical and ethical imperative to provide effective treatment for youth depression with an acceptable risk-benefit balance. Long-chain omega-3 polyunsaturated fatty acids (PUFAs) play an important role in a range of physiological processes in living organisms. Supplementation with omega-3 PUFAs has been shown to have a range of beneficial effects on both physical and mental health, and results of previous trials suggest that omega-3 PUFAs may be a safe and effective treatment for depression. However, conclusions from these trials have been limited by their relatively small s le sizes. This trial will test the effectiveness of a 12-week parallel group, double-blind, randomized, placebo-controlled trial of 1.4 g day(-1) omega-3 PUFAs in help seeking 15- to 25-year-olds (N = 400) presenting with major depressive disorder. The primary hypothesis is that young people will show greater improvement of depressive symptoms after 12 weeks of treatment with omega-3 PUFAs plus cognitive behavioural case management compared with treatment with placebo plus cognitive behavioural case management. Because of using a large s le, results from this study will provide the strongest evidence to date to inform the use of omega-3 PUFAs as first-line therapy in young people presenting with major depressive disorder. The study also heralds an important step towards indicated prevention of persistent depression, which may reduce the burden, stigmatization, disability and economic consequences of this disorder.
Corpus callosum shape alterations in individuals prior to the onset of psychosis
Publisher: Elsevier BV
Date: 08-2008
DOI: 10.1016/J.SCHRES.2008.04.042
Abstract: Reductions in the size of the anterior callosum have been described for both first-episode schizophrenia-spectrum psychosis and established schizophrenia, but have not been examined in in iduals at ultra-high risk for psychosis (UHR). We compared 100 UHR in iduals (27 of whom later developed psychosis) with 38 age-matched control subjects on measures of size and shape of the corpus callosum to determine if changes previously demonstrated in first-episode and established schizophrenia are present in the pre-psychotic phase. Each in idual's callosum was extracted from the mid-sagittal slice from T1-weighted magnetic resonance images, and total area, length and curvature of the callosum was compared using one-way ANOVA, and 39 regional thicknesses via a non-parametric permutation method to account for non-independence of adjacent measures. Total area, length and curvature did not differ between the groups. Compared to both the UHR-NP group and controls, the UHR-P group showed significant regional reductions in the region of the anterior genu of the callosum. The UHR-NP group did not differ from controls. Positive and negative symptoms did not affect regional thickness in either of the patient groups. Cox regression showed that mean anterior genu thickness was highly predictive of a transition to psychosis. Reductions in the thickness of the anterior callosum differentiate between high-risk in iduals who transition to psychosis and those who do not, and is highly predictive of transition. These changes may reflect primary pathology of orbitofrontal and medial frontal cortex, or deficits in anterior interhemispheric myelination.
Generalized and specific cognitive performance in clinical high-risk cohorts: A review highlighting potential vulnerability markers for psychosis
Publisher: Oxford University Press (OUP)
Date: 28-09-2006
Does disturbance of self underlie social cognition deficits in schizophrenia and other psychotic disorders?
Publisher: Wiley
Date: 05-2009
DOI: 10.1111/J.1751-7893.2009.00112.X
Abstract: Although the different approaches to psychosis research have made significant advances in their own fields, integration between the approaches is often lacking. This paper attempts to integrate a strand of cognitive research in psychotic disorders (specifically, social cognition research) with phenomenological accounts of schizophrenia and other psychotic disorders. The paper is a critical investigation of phenomenological models of disturbed selfhood in schizophrenia in relation to cognitive theories of social cognition in psychotic disorders. We argue that disturbance of the basic sense of self, as articulated in the phenomenological literature, may underlie the social cognition difficulties present in psychotic disorders. This argument is based on phenomenological thinking about self-presence ('ipseity') being the primary or most basic ground for the intentionality of consciousness - that is, the directedness of consciousness towards others and the world. A disruption in this basic ground of conscious life has a reverberating effect through other areas of cognitive and social functioning. We propose three routes whereby self-disturbance may compromise social cognition, including dissimilarity, disruption of lived body and disturbed mental coherence. If this model is supported, then social cognition difficulties may be thought of as a secondary index or marker of the more primary disturbance of self in psychotic disorders. Further empirical work examining the relationship between cognitive and phenomenological variables may be of value in identifying risk markers for psychosis onset, thus contributing to early intervention efforts, as well as in clarifying the essential psychopathological features of schizophrenia and other psychotic disorders.
The Ultra-High-Risk for psychosis groups: Evidence to maintain the status quo
Publisher: Elsevier BV
Date: 05-2018
DOI: 10.1016/J.SCHRES.2017.09.003
Abstract: In iduals are considered Ultra-High-Risk (UHR) for psychosis if they meet a set of standardised criteria including presumed genetic vulnerability (Trait), or a recent history of Attenuated Psychotic Symptoms (APS) or Brief Limited Intermittent Psychotic Symptoms (BLIPS). Recent calls to revise these criteria have arisen from evidence that Trait, APS and BLIPS groups may transition to psychosis at different rates. Concurrently, it has become clear that the UHR status confers clinical risk beyond transition to psychosis. Specifically, most UHR in iduals will not develop psychosis, but will experience high rates of non-psychotic disorders, persistent APS and poor long-term functional outcomes. Rather than focus on transition, the present study investigated whether UHR groups differ in their broader clinical risk profile by examining baseline clinical characteristics and long-term outcomes other than transition to psychosis. Four UHR groups were defined: Trait-only, APS-only, Trait+APS, and any BLIPS. Participants (N=702) were recruited upon entry to early intervention services and followed-up over a period of up to 13years (mean=4.53, SD=3.84). The groups evidenced similar symptom severity (SANS for negative symptoms, BPRS for positive and depression/anxiety symptoms) and psychosocial functioning (SOFAS, GAF, QLS) at baseline and follow-up as well as similar prevalence of non-psychotic disorders at follow-up. Our findings demonstrate that UHR groups evidence a similar clinical risk profile when we expand this beyond transition to psychosis, and consequently support maintaining the existing UHR criteria.
Physical health promotion for young people at ultra‐high risk for psychosis: An application of the COM‐B model and behaviour‐change wheel
Publisher: Wiley
Date: 19-07-2016
DOI: 10.1111/INM.12243
Cognitive deficits in youth with familial and clinical high risk to psychosis: A systematic review and meta-analysis
Publisher: Wiley
Date: 11-03-2014
DOI: 10.1111/ACPS.12261
Abstract: It is likely that cognitive deficits are vulnerability markers for developing schizophrenia, as these deficits are already well-established findings in first-episode psychosis. Studies at-risk adolescents and young adults are likely to provide information about cognitive deficits that predate the onset of the illness. We conducted meta-analyses of studies comparing familial-high risk (FHR) or ultra-high risk (UHR n = 2113) and healthy controls (n = 1748) in youth studies in which the mean age was between 15 and 29. Compared with controls, high risk subjects were impaired in each domain in both UHR (d = 0.34-0.71) and FHR (d = 0.24-0.81). Heterogeneity of effect sizes across studies was modest, increasing confidence to the findings of the current meta-analysis (I(2) = 0-0.18%). In both risk paradigms, co-occurrence of genetic risk with attenuated symptoms was associated with more severe cognitive dysfunction. In UHR, later transition to psychosis was associated with more severe cognitive deficits in all domains (d = 0.31-0.49) except sustained attention. However, cognitive impairment has a limited capacity to predict the outcome of high-risk patients. Cognitive deficits are already evident in adolescents and young adults who have familial or clinical risk for psychosis. Longitudinal developmental studies are important to reveal timing and trajectory of emergence of such deficits.
Should attenuated psychosis syndrome be included in DSM-5?
Publisher: Elsevier BV
Date: 02-2012
NEURAPRO: a multi-centre RCT of omega-3 polyunsaturated fatty acids versus placebo in young people at ultra-high risk of psychotic disorders—medium-term follow-up and clinical course
Publisher: Springer Science and Business Media LLC
Date: 25-06-2018
DOI: 10.1038/S41537-018-0052-X
Abstract: This study reports a medium-term follow-up of a randomised, double-blind, placebo-controlled trial of omega-3 polyunsaturated fatty acids (PUFA) in ultra-high risk for psychosis (UHR) patients. Primary outcomes of interest were transition to psychosis and symptomatic and functional outcome. A secondary aim was to investigate clinical predictors of medium-term outcome. Three hundred four UHR participants were recruited across 10 specialised early psychosis services in Australia, Asia, and Europe. The intervention consisted of 1.4 g/daily of omega-3 PUFA or placebo, plus up to 20 sessions of cognitive-behavioural case management (CBCM), over the 6-month study period, with participants receiving further CBCM sessions on basis of need between months 6–12. Mean time to follow-up was 3.4 (median = 3.3 SD = 0.9) years. There was a modest increase in transitions between 12-month and medium-term follow-up (11–13%) and substantial improvement in symptoms and functioning between baseline and follow-up, with no differences between the treatment groups. Most improvement had been achieved by end of the intervention. 55% of the s le received mental health treatment between end of intervention and follow-up. Omega-3 PUFA did not provide additional benefits to good quality psychosocial intervention over the medium term. Although most improvement had been achieved by end of intervention the substantial rates of post-intervention mental health service use indicate longer-term clinical need in UHR patients. The post-intervention phase treatment or the longer-term effect of CBCM, or a combination of the two, may have contributed to maintaining the gains achieved during the intervention phase and prevented significant deterioration after this time.
Aerobic Exercise Improves Cognitive Functioning in People With Schizophrenia: A Systematic Review and Meta-Analysis
Publisher: Oxford University Press (OUP)
Date: 11-08-2016
Substance use in youth at risk for psychosis
Publisher: Elsevier BV
Date: 03-2017
DOI: 10.1016/J.SCHRES.2016.08.026
Abstract: People with schizophrenia have high rates of substance use which contributes to co-morbidity and premature mortality. Some evidence suggests people at-risk for psychosis have high rates of substance use. We aimed to assess substance use in a help-seeking cohort, comparing those at-risk and not at-risk for psychosis, and to establish any relationship with clinical symptoms. Participants were help-seeking youth presenting to mental health services in Sydney and Melbourne. 279 (34.8%) were at-risk for psychosis, and 452 (56.4%) did not meet criteria for a psychotic disorder or risk for psychosis. The excluded in iduals were made up of 59 (7.4%) young people who met criteria for a psychotic disorder and 11 (1.4%) who were unable to be evaluated. We assessed the association of substance use involvement with risk status and clinical symptoms using multivariate regression. In iduals at-risk for psychosis had significantly higher tobacco, alcohol and cannabis use than those not at-risk. Multivariate analysis revealed at-risk status was significantly associated with higher alcohol involvement scores when adjusting for age and gender, but no association was found for cannabis or tobacco. At-risk status was no longer associated with alcohol involvement when cannabis or tobacco use was added into the analysis. Tobacco smoking, alcohol consumption and cannabis use are common in help-seeking youth, particularly those at-risk for psychosis. It is important to consider co-occurring use of different substances in adolescents. Early substance misuse in this phase of illness could be targeted to improve physical and mental health in young people.
EVIDENCE FOR ALTERED ASYMMETRY OF FRONTAL CORTEX T2 RELAXATION TIME IN PATIENTS AT CLINICAL HIGH-RISK FOR PSYCHOSIS
Publisher: Elsevier BV
Date: 04-2010
The Human Face of Biobank Networks for Translational Research
Publisher: Mary Ann Liebert Inc
Date: 09-2011
Abstract: The biobanking literature frequently addresses donor and societal issues surrounding biobanking, but the biobanker's perspective is rarely highlighted. While not comprehensive, this article offers an overview of the human aspects of biobanking from the viewpoint of biobank personnel-from biobank formation, through the process, and in addressing post-biobanking issues. As every biobank and biobank network may differ, such factors may vary. Before biobanking can commence, the purpose of the biobank network must be defined, and buy-in achieved from many stakeholders. An attitude of trust and sharing is essential, as is good communication. Developing a biobank is time consuming and laborious. Forming a network requires significantly more time due to the need for cross-institutional harmonization of policies, procedures, information technology considerations, and ethics. Circumstances may dictate whether development occurs top-down and/or bottom-up, as well as whether network management may be independent or by personnel from participating biobanks. Funding tends to be a prominent issue for biobanks and networks alike. In particular, networks function optimally with some level of government support, particularly for personnel. Quality biospecimen collection involves meticulously documented coordination with a network of medical and nursing staff. Examining and s ling operative specimens requires timely collaboration between the surgical and pathology teams. "Catch rates" for s les may be difficult to predict and may occur at a frequency less than anticipated due to factors related to the institution, staff, or specimen. These factors may affect specimen quality, and have a downstream effect on competition for specimens for research. Thus, release of s les requires a fair, carefully constructed s le access policy, usually incorporating an incentive for researchers, and an encouragement to form collaborations. Finally, the public and patient groups should aim to understand the benefits of a biobank network, so that patient care is improved through coordinated biobanking activity.
Neurological soft signs in prodromal patients
Publisher: Elsevier BV
Date: 1998
The prognostic significance of attenuated psychotic symptoms in help-seeking youth
Publisher: Elsevier BV
Date: 2020
DOI: 10.1016/J.SCHRES.2019.10.016
Abstract: Recent findings suggest that attenuated psychotic symptoms (APS) might serve as a risk factor for general mental health impairment in help-seeking youth. The current study was designed to test this possibility by examining the prognostic significance of APS in a large cohort of help-seeking youth not selected for psychosis risk. 465 youth aged 12-25 referred to general youth mental health services were grouped as either APS + or APS- based on whether or not they met 'ultra high risk' for psychosis APS risk criteria as assessed using the Comprehensive Assessment of At Risk Mental States (CAARMS). They completed clinical assessments at baseline and at 12-month follow-up, measuring a range of psychopathology (depression, anxiety, eating disorders, general psychological distress, substance abuse) and psychosocial functioning. APS + had significantly poorer outcomes at 12-months on a range of clinical variables, even after adjusting for baseline scores and amount of treatment received. However, the APS + group showed greater improvement in functioning at follow-up compared to APS-. Attenuated psychotic symptoms are a prognostic indicator of persistent transdiagnostic mental health problems and reduced response to treatment in help-seeking youth over the short term. Hence, it is critical to screen and assess attenuated psychotic symptoms at the primary and secondary mental health services level, especially given that these subclinical symptoms are rarely voluntarily reported.
Can clinicians predict psychosis in an ultra high risk group?
Publisher: SAGE Publications
Date: 07-2010
DOI: 10.3109/00048671003620210
Abstract: Aims: Criteria for identifying people likely to develop a first psychotic episode are now used in many clinical services worldwide. In recent years within these services, there has been an increase in the practice of prescribing antipsychotic medication with the aim of reducing symptoms and preventing onset of full-blown disorder. This practice is based on clinical impression of an incipient psychosis, that is, a clinical judgment that a particular patient may soon progress to full-threshold disorder and may therefore benefit from antipsychotics. However, it is unclear how accurate this clinical impression is. If not accurate it could mean that in iduals are receiving antipsychotics unnecessarily. In this study, we investigated the predictive validity of clinical impression of whether ultra high risk patients would develop frank psychosis. Methods: Experienced psychologists rated their clinical impression of incipient psychosis in 168 ultra high risk patients. Ratings were made upon entry to the PACE clinic, a clinical service for ultra high risk patients. Psychosis status over the subsequent 12-month period was established using the Comprehensive Assessment of At Risk Mental States or State medical records. Results: A total of 8.9% of the s le transitioned to psychosis over the 12-month follow-up period. There was a sensitivity of 0.80, specificity of 0.84, positive predictive value (PPV) of 0.32 and negative predictive value (NPV) of 0.98 for the prediction of psychosis using the clinical impression ratings. Conclusions: The results indicate that clinical impression is not sufficient for predicting psychosis outcome in ultra high risk cohorts and that ongoing rigorous research into predictors of outcome in such cohorts is required. The results also caution against the prescription of antipsychotic medication based on clinical impression of incipient psychosis. Future work should address the predictive validity of clinical impression with a larger s le and over a longer follow-up period.
Mobile Phone Ownership and Endorsement of “mHealth” Among People With Psychosis: A Meta-analysis of Cross-sectional Studies
Publisher: Oxford University Press (OUP)
Date: 22-09-2015
Treatment of people at ultra‐high risk for psychosis
Publisher: Wiley
Date: 12-05-2017
DOI: 10.1002/WPS.20424
Larger left hippocampal volume predicts transition to psychosis in an ultra high-risk group
Publisher: Elsevier BV
Date: 2000
NEURAPRO‐E study protocol: a multicentre randomized controlled trial of omega‐3 fatty acids and cognitive‐behavioural case management for patients at ultra high risk of schizophrenia and other psychot
Publisher: Wiley
Date: 16-08-2015
DOI: 10.1111/EIP.12260
Abstract: Recent research has indicated that preventative intervention is likely to benefit patients 'at-risk' for psychosis, both in terms of symptom reduction and delay or prevention of onset of threshold psychotic disorder. The strong preliminary results for the effectiveness of omega-3 polyunsaturated fatty acids (PUFAs), coupled with the falling transition rate in ultra high-risk (UHR) s les, mean that further study of such benign, potentially neuroprotective interventions is clinically and ethically required. Employing a multicentre approach, enabling a large s le size, this study will provide important information with regard to the use of omega-3 PUFAs in the UHR group. This trial is a 6-month, double-blind, randomized placebo-controlled trial of 1.4 g day This is the protocol of the NeuraproE study. Utilizing a large s le, results from this study will be important in informing indicated prevention strategies for schizophrenia and other psychotic disorders, which may be the strongest avenue for reducing the burden, stigmatization, disability and economic consequences of these disorders.
People at risk of schizophrenia and other psychoses: comments on the Edinburgh High-Risk Study
Publisher: Royal College of Psychiatrists
Date: 12-1999
Identification of the Population
Publisher: Wiley
Date: 2005
Back to the Future
Publisher: American Medical Association (AMA)
Date: 2008
EXPERIENCE OF TRAUMA AND CONVERSION TO PSYCHOTIC DISORDER IN INDIVIDUALS AT ULTRA HIGH RISK (PRODROMAL) OF DEVELOPING FIRST EPISODE PSYCHOSIS
Publisher: Elsevier BV
Date: 04-2010
Lithium suppression of tau induces brain iron accumulation and neurodegeneration
Publisher: Springer Science and Business Media LLC
Date: 12-07-2016
DOI: 10.1038/MP.2016.96
Abstract: Lithium is a first-line therapy for bipolar affective disorder. However, various adverse effects, including a Parkinson-like hand tremor, often limit its use. The understanding of the neurobiological basis of these side effects is still very limited. Nigral iron elevation is also a feature of Parkinsonian degeneration that may be related to soluble tau reduction. We found that magnetic resonance imaging T
What drives poor functioning in the at-risk mental state?
Publisher: Elsevier BV
Date: 11-2014
DOI: 10.1016/J.SCHRES.2014.09.012
Abstract: Transition to psychotic disorder has been the traditional outcome of interest for research in the at-risk mental state (ARMS). However, there is growing recognition that in iduals with ARMS may function poorly regardless of whether they develop psychosis. We aimed to review the literature to determine whether there are specific factors associated with, or predictive of, functional impairment in the ARMS population. An electronic database search of MEDLINE, PsycINFO and Embase from inception until May 2014 was conducted using keyword search terms synonymous with the at-risk mental state and functioning. Eligible studies were original peer-reviewed English language research articles with populations that met validated at-risk diagnostic criteria and examined the cross-sectional or longitudinal association between any variable and a measure of functioning. Seventy-two eligible studies were identified. Negative symptoms and neurocognitive impairment were associated with poor functioning in cross-sectional studies. Negative and disorganised symptoms, neurocognitive deficits and poor functioning at baseline were predictive of poor functional outcome in longitudinal studies. Positive symptoms were unrelated to functioning in both cross-sectional and longitudinal studies. Functional disability was persistent and resistant to current treatments. Negative and disorganised symptoms and cognitive deficits pre-date frank psychotic symptoms and are risk factors for poor functioning. This is consistent with a subgroup of ARMS in iduals potentially having neurodevelopmental schizophrenia. Treatments aimed at improving functioning must be considered a priority on par with preventing transition to psychosis in the development of future interventions in the ARMS group.
The pace clinic: Development of a clinical service for young people at high risk of psychosis
Publisher: SAGE Publications
Date: 10-1995
DOI: 10.3109/10398569509085280
Abstract: The Pace Clinic (Personal Assessment And Crisis Evaluation) is a newly established clinic which focuses on adolescents and young adults who are at risk of developing a psychotic disorder in the near future. It aims to assess, manage and prospectively study in iduals who may be in the prodromal phase of psychosis. Until now it has not been possible to gain access to large numbers of patients in this pre-psychotic state. This paper describes developments that have allowed this to occur. This Clinic has a potentially important role in research into the aetiology of psychotic disorders, the process of transition from prodromal state to psychosis, and in the development of preventative strategies in psychosis.
A preliminary evaluation of the validity of at-risk criteria for bipolar disorders in help-seeking adolescents and young adults
Publisher: Elsevier BV
Date: 12-2010
DOI: 10.1016/J.JAD.2010.06.016
Abstract: We have developed ultra-high risk criteria for bipolar affective disorder (bipolar at-risk - BAR) which include general criteria such as being in the peak age range of the onset of the disorder and a combination of specific criteria including sub-threshold mania, depressive symptoms, cyclothymic features and genetic risk. In the current study, the predictive validity of these criteria were tested in help-seeking adolescents and young adults. This medical file-audit study was conducted at ORYGEN Youth Health (OYH), a public mental health program for young people aged between 15 and 24years and living in metropolitan Melbourne, Australia. BAR criteria were applied to the intake assessments of all non-psychotic patients who were being treated in OYH on 31 January, 2008. All entries were then checked for conversion criteria. Hypomania/mania related additions or alterations to existing treatments or initiation of new treatment by the treating psychiatrist served as conversion criteria to mania. The BAR criteria were applied to 173 intake assessments. Of these, 22 patients (12.7%) met BAR criteria. The follow-up period of the s le was 265.5days on average (SD 214.7). There were significantly more cases in the BAR group (22.7%, n=5) than in the non-BAR group (0.7%, n=1) who met conversion criteria (p<.001). These findings support the notion that people who develop a first episode of mania can be identified during the prodromal phase. The proposed criteria need further evaluation in prospective clinical trials.
Setting the stage: From prodrome to treatment resistance in bipolar disorder
Publisher: Wiley
Date: 11-2007
DOI: 10.1111/J.1399-5618.2007.00484.X
Abstract: Bipolar disorder is common, and both difficult to detect and diagnose. Treatment is contingent on clinical needs, which differ according to phase and stage of the illness. A staging model could allow examination of the longitudinal course of the illness and the temporal impact of interventions and events. It could allow for a structured examination of the illness, which could set the stage for algorithms that are tailored to the in iduals needs. A staging model could further provide as structure for assessment, gauging treatment and outcomes. The model incorporates prodromal stages and emphasizes early detection and algorithm appropriate intervention where possible. At the other end of the spectrum, the model attempts to operationalize treatment resistance. The utility of the model will need to be validated by empirical research.
Prediction of a single psychotic episode: A 7.5-year, prospective study in first-episode psychosis
Publisher: Elsevier BV
Date: 02-2011
DOI: 10.1016/J.SCHRES.2010.10.020
Abstract: Around 20% of patients who suffer from psychosis will experience a single psychotic episode (SPE), but relatively little is known about the characteristics and predictors for this group of patients. This study sought to: 1) characterise the subgroup of first-episode psychosis (FEP) patients who experienced a SPE over a 7.5-year follow-up and 2) to identify significant predictors for this subgroup independent of potential confounders. A representative s le of 413 FEP patients treated at a specialist early psychosis service were assessed at baseline and followed-up for 7.5 years. Binary logistic regression models were employed to investigate univariate and adjusted associations between baseline predictors and experiencing a SPE. Results were adjusted for the influence of known prognostic factors for psychosis. Follow-up data was available for 274 participants. Forty-six (16.5%) achieved clinical remission and experienced no recurrence over the follow-up period. Duration of untreated psychosis (DUP) shorter than 60 days (OR=3.89, p=0.007), more rapid response to antipsychotic treatment (OR=0.33, p=0.019) and no parental loss (OR=5.25, p=0.045) significantly predicted a SPE. The association remained significant after controlling for potential confounders. Early treatment (within two months of onset of psychotic symptoms) and social support significantly reduce vulnerability to subsequent psychotic episodes. Future studies need to investigate the interplay between biological factors (i.e. sensitized dopaminergic system), environmental variables (i.e. exposure to trauma, stigma and discrimination), and psychological attributes (i.e. cognitive schemata) in order to elucidate the processes underlying the vulnerability to recurrent psychotic episodes.
Toward Improved Risk Prediction in Individuals at High Risk of Psychotic Disorders
Publisher: American Psychiatric Association Publishing
Date: 10-2015
The Validity and Value of Self-reported Physical Activity and Accelerometry in People With Schizophrenia: A Population-Scale Study of the UK Biobank
Publisher: Oxford University Press (OUP)
Date: 24-10-2017
Sustained attention in young people at high risk of psychosis does not predict transition to psychosis
Publisher: Elsevier BV
Date: 11-2005
DOI: 10.1016/J.SCHRES.2005.06.023
Abstract: Early detection of imminent psychosis allows for the possibility of interventions to prevent onset, or to minimise severity and disability. It also has potential to enhance knowledge of the factors important in the etiology of psychotic illnesses. Neurocognitive deficits are well documented in psychotic illnesses and there is evidence to suggest that such deficits are present in in iduals long before they develop the illness. Further, it has been proposed that such impairments may indicate an underlying predisposition to develop psychosis and may thus be described as 'vulnerability indicators'. This study aimed to investigate the proposed vulnerability indicator of impaired sustained attention in young people thought to be at ultra high-risk of developing psychosis imminently to see whether it would improve the prediction of psychosis in this group. The Continuous Performance Test - Identical Pairs (CPT-IP) version performance of an ultra high-risk group (UHR, N=70) was compared with that of a healthy comparison group (NC, N=51) and a first-episode psychosis group (FEP, N=32). The UHR group exhibited performance deficits compared to the NC group and performed at a level similar to that of the FEP group. However, within the UHR group, those who developed psychosis within the timeframe of the study did not differ from those who did not develop psychosis on their CPT-IP performance. These results support sustained attention as an indicator of vulnerability to psychosis, but suggest that CPT-IP performance does not help to predict transition to psychosis in an ultra high-risk group.
Ultra high risk (UHR) for psychosis criteria: Are there different levels of risk for transition to psychosis?
Publisher: Elsevier BV
Date: 2011
DOI: 10.1016/J.SCHRES.2010.10.017
Abstract: The ultra high risk (UHR) for psychosis criteria have been validated in a number of studies. However, it is not known whether particular UHR criteria (Attenuated Psychotic Symptoms (APS), Brief Limited Intermittent Psychotic Symptoms (BLIPS) or Trait vulnerability criteria), or combination of criteria, is associated with a higher risk of transition to psychosis. The current study investigated this issue over a 6-month follow-up period. We hypothesised that the risk of transition would increase in the following order: Trait alone<APS alone < APS+Trait<BLIPS. Data on UHR intake criteria and transition to psychosis status at 6 months were analysed for UHR patients seen at the PACE clinic, Orygen Youth Health between January 2000 and November 2008. A total of 928 new referrals were accepted into the PACE clinic over this period of whom 817 (88%) had baseline information available for analysis. The percentage of subjects who presented with APS, Trait and BLIPS were 83%, 27% and 4%, respectively. When the two intermediate groups (APS alone and APS+Trait) were combined, there was evidence that the risk of transition increased in the order of Trait alone<APS<BLIPS (p=0.024, adjusted analysis). Our data suggest that UHR intake criteria predict transition over 6 months in the order of Trait alone<APS<BLIPS. The fact that BLIPS patients are at the highest risk of transition over the short term is consistent with the "early" versus "late" prodrome model. It also indicates that particular clinical attention may need to be paid to BLIPS patients, especially early in the course of treatment.
At risk or not at risk? A meta‐analysis of the prognostic accuracy of psychometric interviews for psychosis prediction
Publisher: Wiley
Date: 25-09-2015
DOI: 10.1002/WPS.20250
Commentary on should the diagnostic boundaries of schizophrenia be expanded?
Publisher: Informa UK Limited
Date: 03-2011
Negative psychotic symptoms and impaired role functioning predict transition outcomes in the at-risk mental state
Publisher: Cambridge University Press (CUP)
Date: 27-02-2013
DOI: 10.1017/S0033291713000251
Abstract: Many research groups have attempted to predict which in iduals 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 in idual symptoms scores. Data from 318 ARMS in iduals 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. LCCA 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. The 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 in idual symptoms.
The NEURAPRO Biomarker Analysis: Long-Chain Omega-3 Fatty Acids Improve 6-Month and 12-Month Outcomes in Youths at Ultra-High Risk for Psychosis
Publisher: Elsevier BV
Date: 02-2020
DOI: 10.1016/J.BIOPSYCH.2019.08.030
Abstract: NEURAPRO was a multicenter, placebo-controlled trial of long-chain omega-3 polyunsaturated fatty acids (n-3 PUFAs) (fish oil) in 304 in iduals at ultra-high risk for psychotic disorders. The study failed to show benefits of n-3 PUFAs over placebo. Although the randomized controlled trial design is placed at the top of the evidence hierarchy, this methodology has limitations in fish oil randomized controlled trials, as not only is the test agent present in the intervention group, but also n-3 fats are present in the diet and the body tissue of all participants. Analysis of biomarker data (eicosapentaenoic acid [EPA], docosahexaenoic acid [DHA], n-3 index, EPA+DHA) collected as part of NEURAPRO was conducted on 218 participants with longitudinal biomarker data to determine if n-3 PUFAs measured in erythrocytes at baseline and month 6 predicted clinical outcomes. Increases of the n-3 index, EPA, and DHA predicted less severe psychopathology and better functioning at both follow-up time points. Higher baseline levels and increases of n-3 index also predicted overall clinical improvement at month 6 (n-3 index baseline: adjusted odds ratio [95% confidence interval (CI)] = 1.79 [1.30-2.48] n-3 PUFA increase: adjusted odds ratio [95% CI] = 1.43 [1.16-1.76]) and at month 12 (n-3 index baseline: adjusted odds ratio [95% CI] = 2.60 [1.71-3.97] n-3 PUFA increase: adjusted odds ratio [95% CI] = 1.36 [1.06-1.74]). These data suggest that n-3 PUFAs can exert therapeutic effects in ultra-high-risk in iduals. This finding has implications for early intervention and treatment guidelines, as n-3 PUFA supplementation can easily and safely be used in a wide variety of settings, from primary care to specialist services.
Physical health promotion in people with schizophrenia: why we should consider the ultra high-risk state.
Publisher: Wiley
Date: 06-12-2016
DOI: 10.1111/ACPS.12532
Should a risk syndrome for first episode psychosis be included in the DSM-5?
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2011
Subclinical psychosis and depression: Co-occurring phenomena that do not predict each other over time
Publisher: Elsevier BV
Date: 08-2011
DOI: 10.1016/J.SCHRES.2011.03.003
Abstract: The path from subclinical psychotic experiences to clinical disorder is thought to be mediated by the persistence of subclinical psychotic experiences. One of the factors that is likely associated with this persistence is depression. Although commonly viewed as interrelated concepts, the exact relationship between subclinical psychosis and depression is not clear. Cross-lagged path modeling was used to explore the relationship between subclinical psychosis and depression across and over time in an adolescent population seeking assistance for non-psychotic disorders (N=138), measured at four occasions over a two-year period. Subclinical psychosis and depression were related to each other at every cross-sectional measurement, but did not predict each other over time. Subclinical psychotic experiences and depressive symptom levels were highest at baseline, when participants presented to the clinical service for help. In addition, the relationship between them was also strongest at baseline and decreased significantly over time. The results suggest that psychosis and depression are interrelated phenomena that strongly co-occur in time, but longitudinally, one does not predict change in the other. Both psychopathological dimensions should be addressed when treatment is provided to adolescent help-seekers.
Persistent negative symptoms in individuals at Ultra High Risk for psychosis
Publisher: Elsevier BV
Date: 04-2019
Recruitment and Treatment Practices for Help-Seeking Prodromal Patients
Publisher: Oxford University Press (OUP)
Date: 19-03-2007
How much physical activity do people with schizophrenia engage in? A systematic review, comparative meta-analysis and meta-regression
Publisher: Elsevier BV
Date: 10-2016
DOI: 10.1016/J.SCHRES.2016.05.017
Abstract: Physical activity (PA) improves health outcomes in people with schizophrenia. It is unclear how much PA people with schizophrenia undertake and what influences PA participation. We conducted a meta-analysis to investigate PA levels and predictors in people with schizophrenia. Major databases were searched from inception till 02/2016 for articles measuring PA (self-report questionnaire (SRQ) or objective measure (e.g. accelerometer)) in people with schizophrenia, including first episode psychosis (FEP). A random effects meta-analysis and meta-regression analysis were conducted. 35 studies representing 3453 in iduals with schizophrenia (40.0years 64.0% male) were included. Engagement in light PA was 80.44min (95% CI 68.32-92.52, n=2658), 47.1min moderate-vigorous PA (95% CI 31.5-62.8, n=559) and 1.05min (95% CI 0.48-1.62, n=2533) vigorous PA per day. People with schizophrenia engaged in significantly less moderate (hedges g=-0.45, 95% CI -0.79 to -0.1, p=0.01) and vigorous PA (g=-0.4, 95% CI -0.60 to -0.18) versus controls. Higher light to moderate, but lower vigorous PA levels were observed in outpatients and in studies utilizing objective measures versus SRQ. 56.6% (95% CI 45.8-66.8, studies=12) met the recommended 150min of moderate physical activity per week. Depressive symptoms and older age were associated with less vigorous PA in meta-regression analyses. Our data confirm that people with schizophrenia engage in significantly less moderate and vigorous PA versus controls. Interventions aiming to increase PA, regardless of intensity are indicated for people with schizophrenia, while specifically increasing moderate-vigorous PA should be a priority given the established health benefits.
Digital smartphone intervention to recognise and manage early warning signs in schizophrenia to prevent relapse: the EMPOWER feasibility cluster RCT
Publisher: National Institute for Health and Care Research
Date: 05-2022
DOI: 10.3310/HLZE0479
Abstract: Relapse is a major determinant of outcome for people with a diagnosis of schizophrenia. Early warning signs frequently precede relapse. A recent Cochrane Review found low-quality evidence to suggest a positive effect of early warning signs interventions on hospitalisation and relapse. How feasible is a study to investigate the clinical effectiveness and cost-effectiveness of a digital intervention to recognise and promptly manage early warning signs of relapse in schizophrenia with the aim of preventing relapse? A multicentre, two-arm, parallel-group cluster randomised controlled trial involving eight community mental health services, with 12-month follow-up. Glasgow, UK, and Melbourne, Australia. Service users were aged 16 years and had a schizophrenia spectrum disorder with evidence of a relapse within the previous 2 years. Carers were eligible for inclusion if they were nominated by an eligible service user. The Early signs Monitoring to Prevent relapse in psychosis and prOmote Wellbeing, Engagement, and Recovery (EMPOWER) intervention was designed to enable participants to monitor changes in their well-being daily using a mobile phone, blended with peer support. Clinical triage of changes in well-being that were suggestive of early signs of relapse was enabled through an algorithm that triggered a check-in prompt that informed a relapse prevention pathway, if warranted. The main outcomes were feasibility of the trial and feasibility, acceptability and usability of the intervention, as well as safety and performance. Candidate co-primary outcomes were relapse and fear of relapse. We recruited 86 service users, of whom 73 were randomised (42 to EMPOWER and 31 to treatment as usual). Primary outcome data were collected for 84% of participants at 12 months. Feasibility data for people using the smartphone application (app) suggested that the app was easy to use and had a positive impact on motivations and intentions in relation to mental health. Actual app usage was high, with 91% of users who completed the baseline period meeting our a priori criterion of acceptable engagement ( 33%). The median time to discontinuation of 33% app usage was 32 weeks (95% confidence interval 14 weeks to ∞). There were 8 out of 33 (24%) relapses in the EMPOWER arm and 13 out of 28 (46%) in the treatment-as-usual arm. Fewer participants in the EMPOWER arm had a relapse (relative risk 0.50, 95% confidence interval 0.26 to 0.98), and time to first relapse (hazard ratio 0.32, 95% confidence interval 0.14 to 0.74) was longer in the EMPOWER arm than in the treatment-as-usual group. At 12 months, EMPOWER participants were less fearful of having a relapse than those in the treatment-as-usual arm (mean difference –4.29, 95% confidence interval –7.29 to –1.28). EMPOWER was more costly and more effective, resulting in an incremental cost-effectiveness ratio of £3041. This incremental cost-effectiveness ratio would be considered cost-effective when using the National Institute for Health and Care Excellence threshold of £20,000 per quality-adjusted life-year gained. This was a feasibility study and the outcomes detected cannot be taken as evidence of efficacy or effectiveness. A trial of digital technology to monitor early warning signs that blended with peer support and clinical triage to detect and prevent relapse is feasible. A main trial with a s le size of 500 (assuming 90% power and 20% dropout) would detect a clinically meaningful reduction in relapse (relative risk 0.7) and improvement in other variables (effect sizes 0.3–0.4). This trial is registered as ISRCTN99559262. This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment Vol. 26, No. 27. See the NIHR Journals Library website for further project information. Funding in Australia was provided by the National Health and Medical Research Council (APP1095879).
Antipsychotic treatment of UHR (‘prodromal’) individuals
Publisher: Wiley
Date: 08-2010
Response to the letters of Dr Amos and Dr Preti and colleagues
Publisher: Elsevier BV
Date: 03-2014
THE RELATIONSHIP BETWEEN TRANSITION TO PSYCHOSIS, AND FUNCTIONAL OUTCOME IN A GROUP AT ULTRA HIGH RISK FOR PSYCHOTIC DISORDER
Publisher: Elsevier BV
Date: 04-2012
Neurocognitive predictors of transition to psychosis: medium- to long-term findings from a sample at ultra-high risk for psychosis
Publisher: Cambridge University Press (CUP)
Date: 07-02-2013
DOI: 10.1017/S0033291713000123
Abstract: In iduals at ultra-high risk (UHR) for psychosis show reduced neurocognitive performance across domains but it is unclear which reductions are associated with transition to frank psychosis. The aim of this study was to investigate differences in baseline neurocognitive performance between UHR participants with (UHR-P) and without transition to psychosis (UHR-NP) and a healthy control (HC) group and examine neurocognitive predictors of transition over the medium to long term. A s le of 325 UHR participants recruited consecutively from the Personal Assessment and Crisis Evaluation (PACE) Clinic in Melbourne and 66 HCs completed a neurocognitive assessment at baseline. The UHR group was followed up between 2.39 and 14.86 (median = 6.45) years later. Cox regression was used to investigate candidate neurocognitive predictors of psychosis onset. The UHR group performed more poorly than the HC group across a range of neurocognitive domains but only performance on digit symbol coding and picture completion differed between the groups. The risk of transition was only significantly associated with poorer performance on visual reproduction [hazard ratio (HR) 0.919, 95% confidence interval (CI) 0.876–0.965, p = 0.001] and matrix reasoning (HR 0.938, 95% CI 0.883–0.996, p = 0.037). These remained significant even after controlling for psychopathology at baseline. This study is the longest follow-up of an UHR s le to date. UHR status was associated with poorer neurocognitive performance compared to HCs on some tasks. Cognition at identification as UHR was not a strong predictor of risk for transition to psychosis. The results suggests the need to include more experimental paradigms that isolate discrete cognitive processes to better understand neurocognition at this early stage of illness.
OLFACTORY IDENTIFICATION DEFICITS ARE A FEATURE OF SCHIZOPHRENIA AFTER IDENTIFICATION AS ULTRA-HIGH RISK AT THE PACE CLINIC
Publisher: Elsevier BV
Date: 04-2010
Bipolar At-Risk Criteria: An Examination of Which Clinical Features Have Optimal Utility for Identifying Youth at Risk of Early Transition From Depression to Bipolar Disorders
Publisher: Oxford University Press (OUP)
Date: 21-11-2016
Motives for substance use among young people seeking mental health treatment
Publisher: Wiley
Date: 28-07-2008
DOI: 10.1111/J.1751-7893.2008.00076.X
Abstract: To explore substance use motives among young people seeking mental health treatment. Participants consisted of 103 young people seeking mental health treatment, who had used drugs or alcohol in the past year. The young people completed a 42-item substance use motives measure based on the Drinking Motives Measure for their most frequently used substance in the past year. Exploratory factor analysis of the substance use motives scale indicated the young people reported using substances for positive and negative drug effects, to socialize with their peers, and to cope with a negative affect. They did not report using substances for enhancement or conformity motives. Coping motives predicted the presence of a current substance use disorder. The findings support the need for integrated treatment approaches within mental health settings, particularly targeted at young people with co-occurring mental health and substance use problems.
Identification and treatment of the prodromal phase of psychotic disorders: perspectives from the PACE Clinic
Publisher: Wiley
Date: 08-2007
Handgrip Strength Is Associated With Hippocampal Volume and White Matter Hyperintensities in Major Depression and Healthy Controls: A UK Biobank Study
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-11-2019
DOI: 10.1097/PSY.0000000000000753
Abstract: Emerging evidence suggests that handgrip strength (a proxy for muscular fitness) is associated with better cognitive performance in people with major depressive disorder (MDD). The underlying processes are unclear, although hippoc al volume (HCV) reductions and white matter hyperintensities (WMHs) have been implicated. Therefore, we investigated the associations between handgrip strength and various brain region volumes and WMHs in MDD and healthy controls (HCs). This study is a cross-sectional analysis of handgrip strength and neuroimaging data from the UK Biobank. Generalized linear models were used to assess the relationship between grip strength and gray matter, white matter, total brain volume, left and right hippoc us volume, and WMHs in MDD and HCs, adjusting for age, sex, education, and body weight. The s le included 527 people with MDD (54.3 ± 7.3 years, 37.2% male) and 1764 HCs (56.6 ± 7.2 years, 53% male). In MDD, stronger handgrip was significantly associated with increased left (coefficient ± SE = 108.1 ± 27.6, t = 3.92) and right (76.8 ± 30.4, t = 2.53) HCV. In HCs, only right HCV related to handgrip strength (44.8 ± 18.1, t = 2.47). Interaction analyses found stronger associations between grip strength and HCV in MDD compared with HCs, for both hippoc al regions. Stronger handgrip was associated with reduced WMHs in people with MDD (−0.24 ± 0.07, t = −3.24) and HCs (−0.11 ± 0.04, t = −2.47). Maximal handgrip strength was not associated with gray matter, white matter, or total brain volumes in either group. Stronger grip strength is associated with greater left and right HCV and reduced WMHs in MDD. Future research should investigate directionality and consider if interventions targeting strength/muscular fitness can improve brain health and reduce the neurocognitive abnormalities associated with MDD.
P.1.e.016 Anatomical abnormalities of the anterior cingulate cortex before the onset of psychosis
Publisher: Elsevier BV
Date: 08-2008
Prediction of psychosis: Setting the stage
Publisher: Royal College of Psychiatrists
Date: 12-2007
Abstract: Treating psychotic disorders in their earliest stages has become a key focus for research and clinical care. This paper reviews evidence of the capacity to identify those at increased risk for psychotic disorder and to intervene in the identified, high-risk in iduals to ameliorate the course of disorder. Issues involved in preventive oriented clinical care are addressed, such as risk/benefit considerations, ethical and safety issues and the value of stage-specific interventions. Clinical predictors identified in recent research, promising intervention trials and proposed clinical practice guidelines are described. An approach based on active engagement, support and monitoring, yet with a conservative approach to medication use is advocated at present. Potential neurobiological processes have been studied and reinforce the sense that this is a critical phase for active treatment, and may prove helpful in understanding the process of transition across stages of illness. More research is required in prediction, neurobiology and treatment
Structural abnormalities in the cuneus associated with Herpes Simplex Virus (type 1) infection in people at ultra high risk of developing psychosis
Publisher: Elsevier BV
Date: 03-2012
Erratum: The effects of vitamin and mineral supplementation on symptoms of schizophrenia: a systematic review and meta-analysis - CORRIGENDUM (Psychological medicine (2017) 47 9 (1515-1527))
Publisher: Cambridge University Press (CUP)
Date: 17-07-2018
The predictive validity of bipolar at-risk (prodromal) criteria in help-seeking adolescents and young adults: A prospective study
Publisher: Wiley
Date: 05-05-2014
DOI: 10.1111/BDI.12205
Abstract: There are no established tools to identify in iduals at risk for developing bipolar disorder. We developed a set of ultra-high-risk criteria for bipolar disorder [bipolar at-risk (BAR)]. The primary aim of the present study was to determine the predictive validity of the BAR criteria. This was a 12-month prospective study that was conducted at Orygen Youth Health Clinical Program, a public mental health program for young people aged 15-24 years in metropolitan Melbourne, Australia. At intake, BAR screen-positive in iduals and a matched group of in iduals who did not meet BAR criteria were observed over a period of 12 months. The BAR criteria include general criteria such as being in the peak age range for the onset of the disorder, as well as sub-threshold mania, depression plus cyclothymic features, and depression plus genetic risk. Conversion to first-episode mania/hypomania was defined by the presence of DSM-IV manic symptoms for more than four days, in line with the DSM-IV definition of hypomania/mania. A total of 559 help-seeking patients were screened. Of the eligible participants, 59 (10.6%) met BAR criteria. Thirty-five participants were included in the BAR group and 35 matched participants were selected to be in the control group. During the follow-up, five BAR patients out of 35 (14.3%) converted to first-episode hypomania/mania as opposed to none in the non-BAR group [χ(2) (1) = 5.38, p = 0.020]. Four out of these five converters had a DSM-IV diagnosis of bipolar I or bipolar II disorder. These findings support the possibility of identification of persons prior to the onset of mania/hypomania. The proposed criteria need further evaluation in larger, prospective studies with longer follow-up periods.
Declining transition rate in ultra high risk (prodromal) services: Dilution or reduction of risk?
Publisher: Oxford University Press (OUP)
Date: 19-03-2007
Decreasing Electron Flux through the Cytochrome and/or Alternative Respiratory Pathways Triggers Common and Distinct Cellular Responses Dependent on Growth Conditions
Publisher: Oxford University Press (OUP)
Date: 06-11-2014
Abstract: Diverse signaling pathways are activated by perturbation of mitochondrial function under different growth conditions.Mitochondria have emerged as an important organelle for sensing and coping with stress in addition to being the sites of important metabolic pathways. Here, responses to moderate light and drought stress were examined in different Arabidopsis (Arabidopsis thaliana) mutant plants lacking a functional alternative oxidase (alternative oxidase1a [aox1a]), those with reduced cytochrome electron transport chain capacity (T3/T7 bacteriophage-type RNA polymerase, mitochondrial, and plastidial [rpoTmp]), and double mutants impaired in both pathways (aox1a:rpoTmp). Under conditions considered optimal for growth, transcriptomes of aox1a and rpoTmp were distinct. Under adverse growth conditions, however, transcriptome changes in aox1a and rpoTmp displayed a highly significant overlap and were indicative of a common mitochondrial stress response and down-regulation of photosynthesis. This suggests that the role of mitochondria to support photosynthesis is provided through either the alternative pathway or the cytochrome pathway, and when either pathway is inhibited, such as under environmental stress, a common, dramatic, and succinct mitochondrial signal is activated to alter energy metabolism in both organelles. aox1a:rpoTmp double mutants grown under optimal conditions showed dramatic reductions in biomass production compared with aox1a and rpoTmp and a transcriptome that was distinct from aox1a or rpoTmp. Transcript data indicating activation of mitochondrial biogenesis in aox1a:rpoTmp were supported by a proteomic analysis of over 200 proteins. Under optimal conditions, aox1a:rpoTmp plants seemed to switch on many of the typical mitochondrial stress regulators. Under adverse conditions, aox1a:rpoTmp turned off these responses and displayed a biotic stress response. Taken together, these results highlight the erse signaling pathways activated by the perturbation of mitochondrial function under different growth conditions.
Is it appropriate to treat people at high‐risk of psychosis before first onset ‐ Yes
Publisher: AMPCo
Date: 05-2012
DOI: 10.5694/MJA12.10668
A systematic review of the nature and correlates of sleep disturbance in early psychosis
Publisher: Elsevier BV
Date: 02-2017
DOI: 10.1016/J.SMRV.2016.01.001
Abstract: Sleep disturbances are common in people with a diagnosis of schizophrenia and have been associated with increased symptom severity, neurocognitive deficits and reduced quality of life. Despite a significant body of literature in this field, there has been limited investigation of sleep disturbance in the early course of the illness. This systematic review aims to synthesise and evaluate the available data exploring sleep in early psychosis, with two key research questions: 1) What is the nature of sleep disturbance in early psychosis? and 2) What are the correlates of sleep disturbance in early psychosis? From an initial search, 16,675 papers were identified, of which 21 met inclusion/exclusion criteria. The preliminary evidence suggests that self-reported sleep disturbances are prevalent in early psychosis and may be associated with symptom severity, as well as elevated rates of both help-seeking and suicidality. Abnormalities in sleep architecture and sleep spindles are also commonly observed and may correlate with symptom severity and neurocognitive deficits. However, due to significant methodological limitations and considerable heterogeneity across studies, evidence to support the reliability of these associations is limited. We outline a research agenda, emphasising the prospective use of gold-standard sleep measurement to investigate the prevalence and nature of sleep disturbances in early psychosis, as well as how these may be related to the onset and persistence of psychotic symptoms.
Sources of clinical distress in young people at ultra high risk of psychosis
Publisher: Elsevier BV
Date: 06-2015
DOI: 10.1016/J.SCHRES.2015.03.022
Abstract: Substantial controversy has been generated since the proposal to include "Attenuated Psychosis Syndrome" in DSM-5, based on research criteria used to identify young people at "ultra high risk" (UHR) for psychosis. The syndrome was ultimately included in the section for further research. The criteria specified that the person experienced attenuated psychotic symptoms (APS) that were sufficiently distressing to warrant clinical attention. Although APS are the main means of determining whether a person meets UHR criteria, clinical experience suggests that such symptoms are often not the main source of clinical distress in this patient group. However, little is known about the sources of distress in the UHR group. We aimed to assess the main sources of clinical distress in UHR patients at the time of referral to a specialized UHR clinic. Sources and intensity of distress in 73 UHR patients were gathered from treating clinicians. The association with transition to psychosis was explored. Of the total s le, 89.04% fulfilled the APS UHR criteria. APS symptoms were reported to be distressing for 58.5% of this subs le, but social and functioning difficulties (78.1%) and depressive symptoms (58.9%) were the highest sources of distress leading UHR patients to seek help. Intensity of distress associated with APS, anxiety symptoms and substance use was associated with transition to psychosis. APS were reported to be distressing for approximately half of UHR patients. The intensity of distress associated to these symptoms may be associated with increased risk for subsequent transition to full threshold psychotic disorder.
Mapping the onset of psychosis: The comprehensive assessment of at risk mental states (CAARMS)
Publisher: Elsevier BV
Date: 03-2003
Stand-alone cognitive behavioural therapy is not in clinical equipoise with antipsychotic treatment – Author's reply
Publisher: Elsevier BV
Date: 07-2018
The role of metformin as a treatment for neuropsychiatric illness
Publisher: Elsevier BV
Date: 11-2022
DOI: 10.1016/J.EURONEURO.2022.09.002
Abstract: Advances in psychopharmacology have been significantly slower to evolve than in other disciplines of medicine and therefore investigation into novel therapeutic approaches is required. Additionally, concurrent metabolic conditions are prevalent among people with mental disorders. Metformin is a widely used hypoglycaemic agent that is now being studied for use beyond diabetes management. Evidence is emerging that metformin has multiple effects on erse neurobiological pathways and consequently may be repurposed for treating mental illness. Metformin may have beneficial neuroimmunological, neuroplastic, neuro-oxidative and neuro-nitrosative effects across a range of psychiatric and neurodegenerative illnesses. Mechanisms include glucose lowering effects and effects on AMP-activated protein kinase (AMPK) signalling, however the best evidence for clinical benefit is through the glucose lowering effects, with other mechanisms less supported by the current evidence base. This narrative review aims to draw together the existing evidence for use of metformin as a psychopharmaceutical and present the role of metformin in the context of physical and psychiatric ill health, including metabolic, endocrinological and cancer domains. It not only has therapeutic potential in medical comorbidity but may have potential in core illness domains.
Not all first-episode psychosis is the same: Preliminary evidence of greater basic self-disturbance in schizophrenia spectrum cases
Publisher: Wiley
Date: 03-07-2013
DOI: 10.1111/J.1751-7893.2012.00381.X
Abstract: Disturbance in the basic sense of self has previously been found to characterize schizophrenia spectrum disorders and to predict onset of psychosis in the ultra-high-risk population. The current study examined basic self-disturbance in a first-episode psychosis (FEP) population. We hypothesized that basic self-disturbance would be more prominent in cases with a schizophrenia spectrum disorder compared to those with other psychoses. Sixteen FEP patients from Orygen Youth Health, Melbourne, were recruited to the study. Participants were assessed using the Examination of Anomalous Self-Experience and the Structured Clinical Interview for DSM-IV. Basic self-disturbance scores were significantly higher in patients with a schizophrenia spectrum diagnosis (n = 8) compared to patients with other psychotic diagnoses (n = 8). The findings are consistent with previous work indicating that the disturbance of the basic sense of self is more characteristic of schizophrenia spectrum psychosis than other psychoses. This may have implications for early diagnosis, clinical formulation and intervention.
Cognitive precursors of severe mental disorders
Publisher: Informa UK Limited
Date: 2013
Neuroprotection in emerging psychotic disorders
Publisher: Wiley
Date: 05-2007
Fair funding for mental health research
Publisher: SAGE Publications
Date: 26-05-2023
Memory impairments identified in people at ultra-high risk for psychosis who later develop first-episode psychosis
Publisher: American Psychiatric Association Publishing
Date: 2005
DOI: 10.1176/APPI.AJP.162.1.71
Abstract: While cognitive deficits are frequently reported in psychotic disorders, it is unclear whether these impairments predate the onset of illness and to what extent they are predictive of later transition to psychosis. The authors studied 37 healthy volunteers and 98 symptomatic, help-seeking patients meeting the inclusion criteria of a treatment program for people at ultra-high risk for psychosis. Of the ultra-high-risk patients, 34 (34.7%) developed psychosis over the course of the investigation. Premorbid and current IQ, attention, memory, and executive functioning were measured with instruments including subtests from the Wechsler Memory Scale-Revised (WMS-R). Analyses compared the ultra-high-risk patients who became psychotic, those who did not become psychotic, and the comparison subjects. Overall, the ultra-high-risk subjects had significantly lower performance IQs than the comparison subjects. Further, impairments were also found in the visual reproduction subtest and the verbal memory index (predominantly owing to lower logical memory scores) of the WMS-R that were specific to the ultra-high-risk-patients who developed psychosis. No other memory, attentional, or executive tasks discriminated between any of the groups. These findings suggest that visuospatial processing impairment and some memory deficits were apparent before the full expression of psychotic illness. Cognitive performance on more complex tasks requiring rapid registration and efficient recall may be compromised before development of first-episode psychosis. Further experimental tasks that challenge these cognitive domains are required to clarify the predictive value of these results.
Amygdala and insula volumes prior to illness onset in bipolar disorder: A magnetic resonance imaging study
Publisher: Elsevier BV
Date: 2012
DOI: 10.1016/J.PSCYCHRESNS.2011.06.010
Abstract: There are now numerous reports of neuroanatomical abnormalities in people with bipolar disorder. However, it remains unclear whether those abnormalities predate the onset of the illness. In this cross-sectional magnetic resonance imaging study, we assessed 11 young people clinically at ultra-high risk of development of psychosis (UHR), who all developed bipolar I or II disorder by follow-up (median time to onset 328 days - UHR-BP), 11 matched UHR participants, who had no psychiatric diagnosis after at least 12 months of follow-up (UHR-Well) and 11 matched healthy controls (HC). Our main outcome measures were amygdala, hippoc us, insula, lateral ventricular and whole brain volumes. Amygdala and insula volume reductions were more pronounced in the UHR-BP than in the UHR-Well and HC group. Lateral ventricle, whole-brain and hippoc al volumes did not differ between groups. If these findings are confirmed, they suggest that imaging investigations could help to distinguish people who will subsequently develop bipolar disorder from those who will not, at least in symptomatically enriched s les.
The onset of psychotic disorder: A loose linkage model
Publisher: Elsevier BV
Date: 03-2003
Intelligence trajectories in individuals at ultra-high risk for psychosis: An 8-year longitudinal analysis
Publisher: Center for Open Science
Date: 17-11-2021
Abstract: Background: Cognitive impairment is a well-documented predictor of transition to a full-threshold psychotic disorder amongst in iduals at ultra-high risk (UHR) for psychosis. However, less is known about whether change in cognitive functioning differs between those who do and do not transition to a psychotic disorder. Studies to date have not examined trajectories in intelligence constructs (e.g., acquired knowledge and fluid intelligence), which have demonstrated marked impairments in in iduals with schizophrenia. This study aimed to examine intelligence trajectories using longitudinal data from three time-points, spanning an average of eight years.Methods: Participants (N=139) at UHR for psychosis completed the Wechsler Abbreviated Scale of Intelligence (WASI) at each follow-up. Linear mixed-effects models mapped changes in WASI Full-Scale IQ (FSIQ) and T-scores on Vocabulary, Similarities, Block Design, and Matrix Reasoning subtests.Results: The s le showed stable and improving trajectories for FSIQ and all subtests. There were no significant differences in trajectories between those who did and did not transition to psychosis and between in iduals with good and poor functional outcomes. However, although not significant, the trajectories of the acquired knowledge subtests erged between transitioned and non-transitioned in iduals (β=−0.12, 95% CI [−0.29, 0.05] for Vocabulary and β=−0.14, 95% CI [−0.33, 0.05] for Similarities). Conclusions: There was no evidence for long-term deterioration in intelligence trajectories in this UHR s le. As the small s le of in iduals who transitioned may have limited our ability to detect subtle differences, future studies with larger s le sizes are needed to explore potential differences in intelligence trajectories between UHR transition groups.
Mapping the Onset of Psychosis: The Comprehensive Assessment of At-Risk Mental States
Publisher: SAGE Publications
Date: 11-2005
DOI: 10.1080/J.1440-1614.2005.01714.X
Abstract: 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 in idual 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 s le 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 s le 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.
Grip Strength Is Associated With Cognitive Performance in Schizophrenia and the General Population: A UK Biobank Study of 476559 Participants
Publisher: Oxford University Press (OUP)
Date: 19-04-2018
At-risk mental state and prediction
Publisher: Cambridge University Press
Date: 19-02-2009
Omega-3 Fatty Acid Supplementation in Adolescents with Borderline Personality Disorder and Ultra-High Risk Criteria for Psychosis: A Post Hoc Subgroup Analysis of a Double—Blind, Randomized Controlled
Publisher: SAGE Publications
Date: 07-2013
DOI: 10.1177/070674371305800705
Abstract: To investigate whether long-chain omega-3 (n-3) polyunsaturated fatty acids (PUFAs) improve functioning and psychiatric symptoms in young people with borderline personality disorder (BPD) who also meet ultra-high risk criteria for psychosis. We conducted a post hoc subgroup analysis of a double-blind, randomized controlled trial. Fifteen adolescents with BPD (mean age 16.2 years, [SD 2.1]) were randomized to either 1.2 g/day n-3 PUFAs or placebo. The intervention period was 12 weeks. Study measures included the Positive and Negative Syndrome Scale, the Montgomery–Åsberg Depression Rating Scale, and the Global Assessment of Functioning. Side effects were documented with the Udvalg for Kliniske Undersøgelser. Fatty acids in erythrocytes were analyzed using capillary gas chromatography. At baseline, erythrocyte n-3 PUFA levels correlated positively with psychosocial functioning and negatively with psychopathology. By the end of the intervention, n-3 PUFAs significantly improved functioning and reduced psychiatric symptoms, compared with placebo. Side effects did not differ between the treatment groups. Long-chain n-3 PUFAs should be further explored as a viable treatment strategy with minimal associated risk in young people with BPD.
The Psychosis High-Risk State
Publisher: American Medical Association (AMA)
Date: 2013
Does specific psychopathology predict development of psychosis in ultra high-risk (UHR) patients?
Publisher: SAGE Publications
Date: 11-02-2013
Abstract: Studies have attempted to identify additional risk factors within the group identified as ‘ultra high risk’ (UHR) for developing psychotic disorders in order to characterise those at highest risk. However, these studies have often neglected clinical symptom types as additional risk factors. We aimed to investigate the relationship between baseline clinical psychotic or psychotic-like symptoms and the subsequent transition to a psychotic disorder in a UHR s le. A retrospective ‘case–control’ methodology was used. We identified all in iduals from a UHR clinic who had subsequently developed a psychotic disorder (cases) and compared these to a random s le of in iduals from the clinic who did not become psychotic within the s ling time frame (controls). The s le consisted of 120 patients (60 cases, 60 controls). An audit tool was used to identify clinical symptoms reported at entry to the clinic (baseline) using the clinical file. Diagnosis at transition was assessed using the Operational Criteria for Psychotic Illness (OPCRIT) computer program. The relationship between transition to a psychotic disorder and baseline symptoms was explored using survival analysis. Presence of thought disorder, any delusions and elevated mood significantly predicted transition to a psychotic disorder. When other symptoms were adjusted for, only the presence of elevated mood significantly predicted subsequent transition (hazard ratio 2.69, p = 0.002). Thought disorder was a predictor of transition to a schizophrenia-like psychotic disorder (hazard ratio 3.69, p = 0.008). Few in idual clinical symptoms appear to be predictive of transition to a psychotic disorder in the UHR group. Clinicians should be cautious about the use of clinical profile alone in such in iduals when determining who is at highest risk.
Clinical trajectories in the ultra-high risk for psychosis population
Publisher: Elsevier BV
Date: 07-2018
DOI: 10.1016/J.SCHRES.2018.01.022
Abstract: Traditionally, research in the ultra-high risk (UHR) for psychosis population has focused on the treatment of existing symptomatology and prevention of transition to psychosis. Recently, there has been an increase in focus on outcomes in in iduals who do not transition to psychosis. However, there is a lack of standardised definitions of remission, recovery, recurrence and relapse in UHR, resulting in the inability to generalise and replicate outcomes. The aims of the current study were to develop definitions for remission, recovery, recurrence and relapse, and apply them to a UHR cohort allowing the identification of longitudinal clinical trajectories. Further stratification in broader categories of favourable and unfavourable outcomes was applied. The predictive value of various baseline factors on specific clinical trajectories was also assessed. 17 different trajectories were identified in a cohort of 202 in iduals within a 12-month period and classified according to the suggested definitions for recovery (35.7%), remission (7.5%), any recurrence (20%), no remission (17.3%), relapse (4.0%) and transition to psychosis (15.8%). Favourable and unfavourable trajectories represented 43.2% and 57.1% respectively. Long duration of untreated symptoms and high depression scores were associated with unfavourable outcomes. It is possible to apply clear definitions of remission, recovery, recurrence, relapse and transition to psychosis to a UHR cohort to evaluate longitudinal clinical trajectories. Acceptance and use of these definitions will help to facilitate comparisons between trials and to improve clinical clarity across the range of available therapeutic options in UHR in iduals.
Women with schizophrenia are at increased risk of breast cancer
Publisher: BMJ
Date: 13-07-2018
A comprehensive review and model of putative prodromal features of bipolar affective disorder
Publisher: Cambridge University Press (CUP)
Date: 14-09-2010
DOI: 10.1017/S0033291710001790
Abstract: Identifying prodromal features that predate the onset of bipolar disorder (BD) may enable the prevention of BD and aid early intervention. This review addresses two key questions: Is there a bipolar prodrome? And, if there is, what are its characteristic features? A comprehensive search of databases (PubMed, Medline, EMBASE and PsycINFO) supplemented by hand searches was used to identify studies of symptoms preceding the onset of BD. Fifty-nine studies were identified, of which 14 met inclusion criteria. Symptoms can predate the onset of BD by months to years and can be categorized as attenuated forms of BD symptoms, general symptoms common to a range of mental disorders, and personality traits, particularly cyclothymia. Two studies provided sufficient data to enable sensitivity and specificity to be calculated. Specificity of several of the features was high ( %) but sensitivity was generally low (all %). We propose a model based on the findings in the studies reviewed to illustrate the potential trajectory to BD and the points at which it may be possible to intervene. Clinical features preceding the onset of BD can be identified. However, conclusions about whether there is a distinct prodrome to BD are restricted by the limitations of current evidence. The high specificity of some features suggests they may be useful in clinical practice. Large-scale longitudinal studies are needed to validate these features and characterize their specificity and sensitivity in independent s les.
Preferences and motivations for exercise in early psychosis
Publisher: Wiley
Date: 14-03-2016
DOI: 10.1111/ACPS.12562
Clinical staging: a heuristic model for psychiatry and youth mental health
Publisher: AMPCo
Date: 10-2007
DOI: 10.5694/J.1326-5377.2007.TB01335.X
Abstract: Diagnosis in psychiatry continues to struggle to fulfil its key purposes, namely to guide treatment and to predict outcome. A clinical staging model, widely used in clinical medicine, could improve the utility of diagnosis in psychiatry, especially in young people with emerging disorders. Clinical staging has immediate potential to improve the logic and timing of interventions in psychiatry, as it does in many complex and potentially serious medical disorders. Interventions could be evaluated in terms of their ability to prevent or delay progression from earlier to later stages of a disorder, and selected by consumers and clinicians on the basis of clear-cut risk-benefit criteria. This would ensure that, as treatments are offered earlier, they remain safe, acceptable and affordable, and potentially more effective. Biological variables and a range of candidate risk and protective factors could be studied within and across stages, and their role, specificity and centrality in risk, onset and progression of disorders clarified. In this way, a clinicopathological framework could be progressively constructed. Clinical staging, with restructuring across and within diagnostic boundaries and explicit operational criteria for extent and progression of disorder, should be actively explored in psychiatry as a heuristic strategy for developing and evaluating earlier, safer, and more effective clinical interventions, and for clarifying the biological basis of psychiatric disorders. Young people with emerging mental and substance use disorders could be the main beneficiaries.
TRAUMA AND RISK OF DEVELOPING PSYCHOSIS IN A HIGH CLINICAL RISK POPULATION: RESULTS FROM A MEDIUM TO LONG TERM FOLLOW-UP STUDY
Publisher: Elsevier BV
Date: 04-2012
A cross-sectional exploration of the clinical characteristics of disengaged (NEET) young people in primary mental healthcare
Publisher: BMJ
Date: 12-2014
Neuroanatomical Predictors of Functional Outcome in Individuals at Ultra-High Risk for Psychosis
Publisher: Oxford University Press (OUP)
Date: 07-2017
WC6A PSYCHOTIC-LIKE EXPERIENCES IN A COMMUNITY SAMPLE OF ADOLESCENTS: ASSOCIATIONS WITH DISTRESS, DEPRESSION AND FUNCTIONING
Publisher: Elsevier BV
Date: 10-2006
Longitudinal Cognitive Performance in Individuals at Ultrahigh Risk for Psychosis: A 10-year Follow-up
Publisher: Oxford University Press (OUP)
Date: 13-10-2018
Abstract: It remains unclear whether the onset of psychosis is associated with deterioration in cognitive performance. The aim of this study was to examine the course of cognitive performance in an ultrahigh risk (UHR) cohort, and whether change in cognition is associated with transition to psychosis and change in functioning. Consecutive admissions to Personal Assessment and Crisis Evaluation (PACE) Clinic between May 1994 and July 2000 who had completed a comprehensive cognitive assessment at baseline and follow-up were eligible (N = 80). Follow-up ranged from 7.3 to 13.4 years (M = 10.4 years SD = 1.5). In the whole s le, significant improvements were observed on the Similarities (P = .03), Information (P .01), Digit Symbol Coding (P .01), and Trail Making Test-B (P = .01) tasks, whereas performance on the Rey Auditory Verbal Learning Test (Trials 1–3) declined significantly (P .01) over the follow-up period. Change in performance on cognitive measures was not significantly associated with transition status. Taking time to transition into account, those who transitioned after 1 year showed significant decline on Digit Symbol Coding, whereas those who did not transition improved on this measure (P = .01 effect size [ES] = 0.85). Small positive correlations were observed between improvements in functioning and improvements in performance on Digit Symbol Coding and Arithmetic (0.24, P = .03 and 0.28, P = .01, respectively). In summary, the onset of psychosis was not associated with deterioration in cognitive ability. However, specific findings suggest that immediate verbal learning and memory, and processing speed may be relevant domains for future risk models and early intervention research in UHR in iduals.
A qualitative study of the prodrome to first-episode major depressive disorder in adolescents
Publisher: S. Karger AG
Date: 2015
DOI: 10.1159/000373894
Abstract: b i Background: /i /b Currently, we lack a clear picture of the evolution of major depressive disorder (MDD) in adolescents. The period of disturbance preceding MDD can be conceptualised as the prodrome. The aim of the study was to explore the prodrome of first-episode MDD retrospectively in a group of help-seeking adolescents using qualitative methodologies. b i S ling and Methods: /i /b Consecutively referred adolescents (15-18 years of age) with first-episode MDD were recruited for this study from Orygen Youth Health, Melbourne, Vic., Australia. After using quantitative methodologies to confirm the index episode of MDD and measure the extent of recovery, the prodrome was investigated in depth using qualitative techniques. b i Results: /i /b Twenty-nine adolescents (20 females and 9 males) and 7 informants (6 mothers and 1 grandmother) participated. All 29 participants had a prodrome of varying lengths (between 6 days and 4 years). The most noticeable symptoms initially were perplexity and confusion and, thereafter, sadness and irritability. A common pattern was a reduction in their ability to fulfil their role accompanied by guilt, self-blame and reduced self-esteem. Around half of the participants had increased thoughts of suicide and increased anxiety. There were gender differences in the patterns of symptoms noticed, with males more commonly noticing a change in how they related to the world and females more commonly noticing a change in the way that they related to others. All informants noticed a prodrome of varying lengths in 2 cases longer, in 2 cases shorter and in 3 cases around the same time period as that noticed by the participant. The changes most commonly noticed by informants were sadness, upset, irritability and reduced self-esteem. The symptoms were fewer in number and sometimes varied from those noticed by the adolescents themselves. b i Conclusions: /i /b Whilst we recognise that this study is vulnerable to autobiographical bias, we took all reasonable measures to minimise this. Symptoms not included in the diagnostic criteria for depression were the earliest changes noticed by the adolescents themselves and are, therefore, potentially important in informing prevention strategies, as is the finding that there are gender differences in the patterns of changes noticed. In addition, parents may provide an additional avenue to help seeking.
Declining transition rates to psychotic disorder in “ultra-high risk” clients: Investigation of a dilution effect
Publisher: Elsevier BV
Date: 2016
DOI: 10.1016/J.SCHRES.2015.11.026
Abstract: During recent years, a decrease has been noted in the rate of transition of ultra-high risk (UHR) clients to a psychotic disorder. Although important to the concept of the at-risk mental state, the reasons for this decline remain largely unknown. We investigated the possibility of a 'dilution effect' in contributing to the decline, i.e. if later UHR cohorts present with less severe clinical intake characteristics than earlier cohorts. Firstly, clinical intake characteristics of a large UHR s le (n=397) were compared across baseline year epochs (1995-2006). Characteristics showing significant differences were included in a Cox-regression to examine if they could explain the decline in transition rates. Secondly, because later cohorts show lower transition rates, 'more stringent' UHR-criteria were retrospectively applied to these cohorts (post-2000, n=219), investigating if this resulted in a higher transition rate. Results indicated that earlier cohorts presented with (1) a larger array of attenuated psychotic symptoms, (2) higher ratings on conceptual disorganization (formal thought disorder) and (3) a higher proportion of in iduals with trait risk factor (all P<.001). However, these factors could not fully account for the decline in transition rates. Applying more stringent UHR-criteria to the post-2000-subs le did not substantially change the rate of transition. Our study suggests that later UHR cohorts presented with different clinical intake characteristics than earlier cohorts. While this may have contributed to the observed decrease in transition rates to psychosis, it does not appear to fully account for this decline, suggesting other factors have also impacted on transition rates over time.
Neurocognitive functioning in the prodrome of mania - An exploratory study
Publisher: Elsevier BV
Date: 05-2013
DOI: 10.1016/J.JAD.2012.09.017
Abstract: Cognitive deficits have been well documented in in iduals with bipolar disorder (BD) after the first episode of mania. However, little is known about the presence of such deficits prior to the initial manic episode. Participants were recruited from a cohort of 416 young people who were at ultra-high risk (UHR) for psychosis and were followed up between 4 and 13 years later. The current report is of 16 participants who developed BD over a mean follow-up period of 8.2 years (UHR-BD). Baseline demographic, clinical and neurocognitive assessment scores were compared with those of 46 age and gender matched UHR subjects who did not transition to psychosis or BD over the follow-up period (UHR-NT) and 66 healthy comparison subjects. UHR-BD subjects had lower global functioning at baseline compared with UHR-NT subjects. There were no significant differences between UHR-BD and UHR-NT subjects on baseline demographic and neurocognitive characteristics. UHR-BD subjects had lower test performance than HC on picture completion, Trail-Making Tests and measures of global intelligence. Small s le size, limited and variable neurocognitive tests utilised and the confounding effects of psychotic symptoms might have impacted on the ability to detect meaningful clinical and neurocognitive differences. In this exploratory study, neurocognition in young people who later develop BD is similar to those of subjects who are at a high risk for psychotic disorders, but there may be certain neurocognitive markers that distinguish this group from unaffected and healthy young people.
Psychosis prediction: 12-Month follow up of a high-risk (prodromal) group
Publisher: Elsevier BV
Date: 03-2003
DOI: 10.1016/S0920-9964(02)00167-6
Abstract: Intervention in the prodromal phase of schizophrenia and related psychoses may result in attenuation, delay or even prevention of the onset of psychosis in some in iduals. However, a "prodrome" is difficult to recognise prospectively because of its nonspecific symptoms. This study set out to recruit and follow up subjects at high risk of transition to psychosis with the aim of examining the predictive power for psychosis onset of certain mental state and illness variables.Symptomatic in iduals with either a family history of psychotic disorder, schizotypal personality disorder, subthreshold psychotic symptoms or brief transient psychotic symptoms were assessed and followed up monthly for 12 months or until psychosis onset. Twenty of 49 subjects (40.8%) developed a psychotic disorder within 12 months. Some highly significant predictors of psychosis were found: long duration of prodromal symptoms, poor functioning at intake, low-grade psychotic symptoms, depression and disorganization. Combining some predictive variables yielded a strategy for psychosis prediction with good sensitivity (86%), specificity (91%) positive predictive value (80%) and negative predictive value (94%) within 6 months. This study illustrates that it is possible to recruit and follow up in iduals at ultra high risk of developing psychosis within a relatively brief follow-up period. Despite low numbers some highly significant predictors of psychosis were found. The findings support the development of more specific preventive strategies targeting the prodromal phase for some in iduals at ultra high risk of schizophrenia.
Olfactory identification deficits at identification as ultra-high risk for psychosis are associated with poor functional outcome
Publisher: Elsevier BV
Date: 02-2015
DOI: 10.1016/J.SCHRES.2014.10.051
Abstract: We have previously reported that olfactory identification (OI) deficits are a promising premorbid marker of transition from ultra-high risk (UHR) to schizophrenia, but not to psychotic illness more generally. Whether this remains the case at longer follow-up, and whether there is decline in OI ability are unclear. The University of Pennsylvania Smell Identification Test (UPSIT) was administered to 81 participants at baseline (identification of risk for psychosis) and 254 in iduals at follow-up. Forty-nine participants underwent UPSIT assessment at both time points. UPSIT scores were investigated at an average of 7.08years after identification of risk in relation to transition to psychosis, a diagnosis of schizophrenia, and psychosocial/functional outcome. UPSIT scores at baseline and follow-up did not differ between participants who transitioned to psychosis and those who did not. Similarly, there were no significant differences on UPSIT scores at baseline or follow-up between in iduals with a diagnosis of schizophrenia and transitioned in iduals without schizophrenia. Those with a poor functional outcome showed significantly lower baseline UPSIT scores than participants with good outcome. There was no significant association between functional outcome and follow-up UPSIT scores. There were no significant changes in UPSIT over time for any group. These results suggest that impaired OI is not a good marker of the onset of psychosis and schizophrenia, but may differentiate UHR in iduals who experience a poor functional outcome, regardless of transition status.
Early Signs Monitoring to Prevent Relapse in Psychosis and Promote Well-Being, Engagement, and Recovery: Protocol for a Feasibility Cluster Randomized Controlled Trial Harnessing Mobile Phone Technolo
Publisher: JMIR Publications Inc.
Date: 09-01-2020
DOI: 10.2196/15058
Abstract: Relapse in schizophrenia is a major cause of distress and disability and is predicted by changes in symptoms such as anxiety, depression, and suspiciousness (early warning signs [EWSs]). These can be used as the basis for timely interventions to prevent relapse. However, there is considerable uncertainty regarding the implementation of EWS interventions. This study was designed to establish the feasibility of conducting a definitive cluster randomized controlled trial comparing Early signs Monitoring to Prevent relapse in psychosis and prOmote Well-being, Engagement, and Recovery (EMPOWER) against treatment as usual (TAU). Our primary outcomes are establishing parameters of feasibility, acceptability, usability, safety, and outcome signals of a digital health intervention as an adjunct to usual care that is deliverable in the UK National Health Service and Australian community mental health service (CMHS) settings. We will assess the feasibility of candidate primary outcomes, candidate secondary outcomes, and candidate mechanisms for a definitive trial. We will randomize CMHSs to EMPOWER or TAU. We aim to recruit up to 120 service user participants from 8 CMHSs and follow them for 12 months. Eligible service users will (1) be aged 16 years and above, (2) be in contact with local CMHSs, (3) have either been admitted to a psychiatric inpatient service or received crisis intervention at least once in the previous 2 years for a relapse, and (4) have an International Classification of Diseases-10 diagnosis of a schizophrenia-related disorder. Service users will also be invited to nominate a carer to participate. We will identify the feasibility of the main trial in terms of recruitment and retention to the study and the acceptability, usability, safety, and outcome signals of the EMPOWER intervention. EMPOWER is a mobile phone app that enables the monitoring of well-being and possible EWSs of relapse on a daily basis. An algorithm calculates changes in well-being based on participants’ own baseline to enable tailoring of well-being messaging and clinical triage of possible EWSs. Use of the app is blended with ongoing peer support. Recruitment to the trial began September 2018, and follow-up of participants was completed in July 2019. Data collection is continuing. The database was locked in July 2019, followed by analysis and disclosing of group allocation. The knowledge gained from the study will inform the design of a definitive trial including finalizing the delivery of our digital health intervention, s le size estimation, methods to ensure successful identification, consent, randomization, and follow-up of participants, and the primary and secondary outcomes. The trial will also inform the final health economic model to be applied in the main trial. International Standard Randomized Controlled Trial Number (ISRCTN): 99559262 isrctn.com/ISRCTN99559262 DERR1-10.2196/15058
The effectiveness of simple psychological and physical activity interventions for high prevalence mental health problems in young people: A factorial randomised controlled trial
Publisher: Elsevier BV
Date: 05-2016
DOI: 10.1016/J.JAD.2016.02.043
Abstract: The prevalence and burden of disease of depression and anxiety disorders in young people necessitates effective early intervention strategies. The aim of this study was to evaluate the effectiveness of low-intensity interventions (problem solving therapy (PST) and physical activity promotion) in young people (15-25 years) with mild-moderate depression and/or anxiety. A 2×2 factorial randomised controlled trial (RCT) with factors of PST versus supportive counselling (control) and behavioural activation physical activity versus lifestyle psychoeducation (control). Help-seeking participants (n=176) were randomised to receive up to 6 manualised intervention sessions. Primary outcomes were post-intervention depressive symptoms (Beck Depression Inventory-II (BDI-II), anxiety symptoms (Beck Anxiety Inventory), and Montgomery-Åsberg Depression Rating Scale (MADRS)). Trial registration ACTRN12608000550303. Depression symptoms were significantly reduced in the physical activity group compared to psychoeducation (BDI-II: d=0.41 (95% CI: 0.07-0.76) MADRS: d=0.48 (95% CI: 0.13-0.82), but not post-intervention anxiety symptoms. PST was not superior to supportive counselling, nor were any interactions between interventions significant. As self reported levels of physical activity did not significantly differ between baseline and end-point in those randomised to the physical activity intervention, it is unclear as to whether some form of physical activity not measured in the trial may have led to the difference in depression symptoms. PST was not superior to supportive counselling in reducing depression and anxiety symptoms in young people. Participants who received the physical activity intervention reported the greatest reduction in depression symptoms, however further research is required to establish the mechanism of action and to determine its effectiveness as an adjunct intervention in routine clinical practice.
0462 PSYCHIATRIC OUTPATIENT CLINIC FOR EMERGING PSYCHOLOGICAL DISORDERS (PREPP PROGRAM): VALIDATION OF THE FRENCH VERSION OF CAARMS
Publisher: Elsevier BV
Date: 10-2006
Cannabis use and symptom severity in individuals at ultra high risk for psychosis: a meta‐analysis
Publisher: Wiley
Date: 07-02-2017
DOI: 10.1111/ACPS.12699
Abstract: We aimed to assess whether in iduals at ultra high risk ( UHR ) for psychosis have higher rates of cannabis use and cannabis use disorders ( CUD s) than non‐ UHR in iduals and determine whether UHR cannabis users have more severe psychotic experiences than non‐users. We conducted a meta‐analysis of studies reporting cannabis use in the UHR group and/or positive or negative symptoms among UHR cannabis users and non‐users. Logit event rates were calculated for cannabis use, in addition to odds ratios to assess the difference between UHR and controls. Severity of clinical symptoms in UHR cannabis users and non‐users was compared using Hedges’ g. Thirty unique studies were included ( UHR n = 4205, controls n = 667) containing data from cross‐sectional and longitudinal studies, and randomised control trials. UHR in iduals have high rates of current (26.7%) and lifetime (52.8%) cannabis use, and CUD s (12.8%). Lifetime use and CUD s were significantly higher than controls (lifetime OR : 2.09 CUD OR : 5.49). UHR cannabis users had higher rates of unusual thought content and suspiciousness than non‐users. Ultra high risk in iduals have high rates of cannabis use and CUD s, and cannabis users had more severe positive symptoms. Targeting substance use during the UHR phase may have significant benefits to an in idual's long‐term outcome.
Social environmental risk factors for transition to psychosis in an Ultra-High Risk population
Publisher: Elsevier BV
Date: 02-2015
DOI: 10.1016/J.SCHRES.2014.10.050
Abstract: Despite social environmental factors such as deprivation, urbanicity, migration and adversity being established risk factors for psychotic disorders, there is a paucity of knowledge on the influence of social environmental risk factors in the UHR population. Firstly, we aimed to investigate the association between social deprivation and risk of transition and secondly, we aimed to investigate the association between migration status and the risk of transition. UHR in iduals at the Personal Assessment and Crisis Evaluation (PACE) service in Melbourne were included. Social deprivation as assessed according to postal code area of residence was obtained from census data and Cox regression analysis was used to calculate hazard ratios. A total of 219 UHR in iduals were included and over the median follow-up time of 4.8years, 32 in iduals (14.6%) were known to have transitioned to a psychotic disorder. 8.8% of UHR in iduals were first generation migrants and 41.9% were second generation migrants. The level of social deprivation was not associated with the risk of transition (p=0.83). Similarly, first or second generation migrants did not have an increased risk of transition to psychosis (p=0.84). Despite being established risk factors for psychotic disorders, social deprivation and migrant status have not been found to increase the risk of transition in a UHR population.
RANDOMIZED CONTROLLED TRIAL OF INTERVENTIONS FOR YOUNG PEOPLE AT ULTRA-HIGH RISK OF PSYCHOSIS: 12-MONTH OUTCOME
Publisher: Elsevier BV
Date: 04-2012
Exploring the impact of adverse childhood experiences on symptomatic and functional outcomes in adulthood: advances, limitations and considerations
Publisher: Cambridge University Press (CUP)
Date: 18-10-2017
DOI: 10.1017/IPM.2017.53
Abstract: Exposure to traumatic experiences in childhood is a risk (and potentially causal) factor for the development of a range of adverse physical and mental health conditions. In addition to the onset of clinical disorders, there is emerging evidence that childhood trauma may also be associated with other long-term outcomes, such as the persistence and severity of an in idual’s symptoms, as well as their long-term social and occupational functioning. However, the reasons for this remain poorly understood. A greater understanding both of the mediators that drive these associations, and those variables that enhance resilience against such damaging experiences may help to inform effective therapeutic interventions. In addition to biological and cognitive measures, there is a need to consider social and environmental factors, such as parental bonding and attachment, when investigating these complex relationships.
Met and unmet need in youth mental health
Publisher: Informa UK Limited
Date: 2008
Effect of ω-3 Polyunsaturated Fatty Acids in Young People at Ultrahigh Risk for Psychotic Disorders
Publisher: American Medical Association (AMA)
Date: 2017
DOI: 10.1001/JAMAPSYCHIATRY.2016.2902
Abstract: A promising treatment to prevent onset and improve outcomes in patients at ultrahigh risk for psychosis is dietary supplementation with long-chain ω-3 polyunsaturated fatty acids (PUFAs). To determine whether treatment with ω-3 PUFAs in combination with a high-quality psychosocial intervention (cognitive behavioral case management [CBCM]) is more effective than placebo plus CBCM. NEURAPRO, a double-blind, placebo-controlled, randomized clinical trial, was conducted from March 1, 2010, to September 30, 2014, in 10 specialized early psychosis treatment services in Australia, Asia, and Europe. The primary analysis used the intention-to-treat approach. A daily dose of 1.4 g of ω-3 PUFAs or placebo (paraffin oil), plus 20 or fewer sessions of CBCM over the 6-month study period. The primary outcome was transition to psychosis status at 6 months. The secondary outcomes were general levels of psychopathology and functioning, as assessed by the Brief Psychiatric Rating Scale (BPRS) (range, 24-168), Scale for the Assessment of Negative Symptoms (SANS) (range, 0-125), Montgomery-Åsberg Depression Rating Scale (MADRS) (range, 0-60), Young Mania Rating Scale (YMRS) (range, 0-44), Social and Occupational Functioning Assessment Scale (SOFAS) (range, 0-100), and the Global Functioning: Social and Role scale (range, 0-10). For SOFAS and Global Functioning: Social and Role scale, higher scores were better for other measures, lower scores were better. In this study of 304 adults at ultrahigh risk for psychotic disorders, 153 (50.3%) received ω-3 PUFAs and 151 (49.7%) received placebo. In all, 139 (45.7%) were male mean (SD) age was 19.1 (4.6) years. The Kaplan-Meier-estimated 6-month transition rates were 5.1% (95% CI, 1.3%-8.7%) in the control group and 6.7% (95% CI, 2.3%-10.8%) in the ω-3 PUFA group. At 12 months, the rates were 11.2% (95% CI, 5.5%-16.7%) in the control group and 11.5% (95% CI, 5.8%-16.9%) in the ω-3 PUFA group. No significant difference was observed between the transition rates of both groups (hazard ratio, 1.1 95% CI, 0.55-2.23 P = .76, stratified log-rank test). This trial clearly failed to replicate the findings of the original single-center trial. The most likely explanation is that ω-3 PUFAs lack efficacy under these conditions. However, the lower-than-expected transition rate may have prevented a test of the main hypothesis. Given the substantial symptomatic and functional improvement in both groups, the other treatments received (ie, CBCM and antidepressants) likely produced a ceiling effect beyond which ω-3 PUFAs, even if effective, could not be shown to confer additional benefits. Nevertheless, the main conclusion is that ω-3 PUFAs are not effective under conditions where good quality, evidence-based psychosocial treatment is available. anzctr.org.au Identifier: 12608000475347.
Sulcogyral pattern and sulcal count of the orbitofrontal cortex in individuals at ultra high risk for psychosis
Publisher: Elsevier BV
Date: 04-2014
DOI: 10.1016/J.SCHRES.2014.02.008
Abstract: Three types of orbitofrontal cortex (OFC) sulcogyral patterns have been identified in the general population. The distribution of these three types has been found to be altered in in iduals at genetic risk of psychosis, and in patients with first episode psychosis (FEP) and chronic schizophrenia. This study aims at establishing whether altered OFC sulcogyral patterns were present in a large cohort of in iduals at ultra high risk (UHR) for psychosis. OFC pattern type was classified and the number of posterior and intermediate sulci present on the surface of the OFC was counted. OFC sulcogyral type and the number of sulci were compared between controls (n=58) and UHR participants who transitioned (n=49) versus those who did not transition (n=77) to psychosis. Finally, the relationship between sulcogyral type and number of sulci with intellectual quotient (IQ), symptom severity and social functioning of UHR in iduals was explored. In line with other studies conducted in chronic schizophrenia and FEP, UHR in iduals who later transitioned to psychosis showed a reduced incidence of the Type I OFC on the right hemisphere compared to controls (χ(2)=19.847, p<0.001). These highly consistent results point towards the protective effect of possessing a Type I OFC in the right hemisphere. Furthermore, OFC sulcus counts revealed that controls presented with a higher number of posterior (right hemisphere χ(2)=11.658, p=0.003) and intermediate sulci (left: χ(2)=6.643, p=0.036 right: χ(2)=11.726, p=0.020) when compared to UHR in iduals. However, no associations between OFC types or sulcus count and IQ, symptoms and functioning were observed.
Reducing risk following self-harm: the need for careful prescribing
Publisher: Royal College of General Practitioners
Date: 25-04-2019
Multiple lifestyle factors and depressed mood: a cross-sectional and longitudinal analysis of the UK Biobank (N = 84,860)
Publisher: Springer Science and Business Media LLC
Date: 12-11-2020
DOI: 10.1186/S12916-020-01813-5
Abstract: There is now evolving data exploring the relationship between depression and various in idual lifestyle factors such as diet, physical activity, sleep, alcohol intake, and tobacco smoking. While this data is compelling, there is a paucity of longitudinal research examining how multiple lifestyle factors relate to depressed mood, and how these relations may differ in in iduals with major depressive disorder (MDD) and those without a depressive disorder, as ‘healthy controls’ (HC). To this end, we assessed the relationships between 6 key lifestyle factors (measured via self-report) and depressed mood (measured via a relevant item from the Patient Health Questionnaire) in in iduals with a history of or current MDD and healthy controls (HCs). Cross-sectional analyses were performed in the UK Biobank baseline s le, and longitudinal analyses were conducted in those who completed the Mental Health Follow-up. Cross-sectional analysis of 84,860 participants showed that in both MDD and HCs, physical activity, healthy diet, and optimal sleep duration were associated with less frequency of depressed mood (all p 0.001 ORs 0.62 to 0.94), whereas screen time and also tobacco smoking were associated with higher frequency of depressed mood (both p 0.0001 ORs 1.09 to 1.36). In the longitudinal analysis, the lifestyle factors which were protective of depressed mood in both MDD and HCs were optimal sleep duration (MDD OR = 1.10 p 0.001, HC OR = 1.08 p 0.001) and lower screen time (MDD OR = 0.71 p 0.001, HC OR = 0.80 p 0.001). There was also a significant interaction between healthy diet and MDD status ( p = 0.024), while a better-quality diet was indicated to be protective of depressed mood in HCs (OR = 0.92 p = 0.045) but was not associated with depressed mood in the MDD s le. In a cross-sectional (OR = 0.91 p 0.0001) analysis, higher frequency of alcohol consumption was surprisingly associated with reduced frequency of depressed mood in MDD, but not in HCs. Our data suggest that several lifestyle factors are associated with depressed mood, and in particular, it calls into consideration habits involving increased screen time and a poor sleep and dietary pattern as being partly implicated in the germination or exacerbation of depressed mood.
Cannabis use in never medicated ultra high-risk and first-episode patients: Relationship to cognition
Publisher: Elsevier BV
Date: 2000
Melbourne high risk study: Olfactory identification ability is impaired in individuals at ultra high-risk for psychosis who later develop schizophrenia
Publisher: Elsevier BV
Date: 03-2003
Changes in metabolic parameters in patients with severe mental illness over a 10-year period: A retrospective cohort study
Publisher: SAGE Publications
Date: 29-09-2016
Abstract: Diabetes, obesity and metabolic syndrome are highly prevalent in patients with severe mental illness and can impose a major physical health burden. To determine how anthropometric and metabolic features changed over time in a retrospective cohort of people with Severe Mental Illness living in Cheshire, UK. In all, 1307 in iduals on the severe mental illness Register were followed up between 2002 and 2012 in UK general practice. Subjects were identified through a pseudanonymised search of general practice registers. Baseline body mass index was 28.6 kg/m 2 increasing to 31.0 at 10-year follow-up ( r 2 = 0.84 p = 0.0002). There was a significant increase in fasting blood glucose from 5.72 to 6.79 mmol/L ( r 2 = 0.48 p = 0.026). Correspondingly, there was a strong positive univariate relation between increase in body mass index and fasting blood glucose ( r 2 = 0.54 p 0.0001) taking into account all measurements. Fasting blood glucose also increased slightly with age ( p = 0.028). With increasing use of statins, total cholesterol fell from 4.5 to 3.9 mmol/L ( r 2 = 0.88 p = 0.0001), as did low-density lipoprotein cholesterol from 3.43 to 2.35 mmol/L ( r 2 = 0.94 p = 0.0001). In multivariate models, adjusting for age, gender, smoking and blood pressure, each unit increase in body mass index (odds ratio = 1.07 [1.01, 1.13] p = 0.031) and triglycerides (odds ratio = 1.28 (1.06, 1.55) p = 0.009) was independently associated with an increased risk of having type 2 diabetes. Increasing body mass index relates to increasing rates of dysglycaemia over time. Measures to encourage weight reduction should be key strategies to reduce dysglycaemia rates in severe mental illness. Prescribing statins may have been effective in improving the lipid profile in this group.
Preventative mental health care: accessing the target population
Publisher: SAGE Publications
Date: 12-1999
DOI: 10.1046/J.1440-1614.1999.00613.X
Abstract: Objective: Preventative approaches to mental illness are becoming a focus of clinical and research settings. To date, however, few clinical programs have been established with this primary aim. This descriptive paper summarises patterns of referral to one service providing clinical care for young people known to be at high risk of developing a psychotic illness. Methods and results: A 20-month survey of referrals to the service revealed that most patients had a prolonged and circuitous route to assessment. Additionally, a lengthy time period elapsed between the onset of symptoms and initiation of help seeking. Conclusions: Information arising from this survey may influence the development of strategies to improve access to this service and others aimed at the prevention of psychosis. Further, this information may affect the development of generalised pre-ventative mental health services for young people.
PACE: a specialised service for young people at risk of psychotic disorders
Publisher: AMPCo
Date: 10-2007
DOI: 10.5694/J.1326-5377.2007.TB01336.X
Abstract: Intervention in the prodromal phase of schizophrenia and related psychotic disorders may prevent or delay the onset of these disorders, or reduce the severity of the psychosis. Identifying the schizophrenia prodrome is difficult, however, because of its non-specific symptoms and the wide symptom variability between in iduals. Over the past 15 years, we have investigated the schizophrenia prodrome and developed criteria for detecting people suspected of experiencing a prodromal phase (ie, they are thought to be at imminent risk of onset of a psychotic disorder). About 35% of those meeting our criteria have developed a psychotic disorder within 12 months. We have established a clinical service, the PACE (Personal Assessment and Crisis Evaluation) Clinic, for people with suspected incipient psychosis, and trialled interventions aimed at preventing or delaying the onset of psychotic disorders. Our results and studies in other countries seem to indicate that psychological and psychosocial interventions, either alone or in combination with pharmacotherapy, may be effective in at least delaying, if not preventing, the onset of a psychotic disorder.
Predictive validity of clinical variables in the at risk for psychosis population: International comparison with results from the North American Prodrome Longitudinal Study
Publisher: Elsevier BV
Date: 03-2011
DOI: 10.1016/J.SCHRES.2010.09.024
Abstract: There has been recent optimism with regard to improving the predictive validity of those in iduals who develop a psychotic disorder from the "Ultra High Risk" (UHR) or putatively prodromal population using combinations of clinical variables. We aimed to test the recent results from a large collaborative consortium in an independent cohort from the PACE (Personal Assistance and Clinical Evaluation) clinic in Australia. The North American Prodrome Longitudinal Study (NAPLS) consortium study reported 5 important clinical predictive variables within their US s le of UHR patients: genetic risk with functional decline high unusual thought content score high suspicion aranoia score low social functioning and history of substance abuse. We examined the predictive validity of these variables using data from a cohort of 104 UHR patients from the PACE clinic in Melbourne, Australia. Cox regression was used to explore the relationship between these variables at baseline and transition to psychosis by 28months. Three of the five variables were found to be associated with transition in our s le: high unusual thought content scores low functioning and having genetic risk with functional decline. A combination of two out of three of these features produced a reasonable predictive validity (positive predictive value (PPV) 65.4%, sensitivity 37.3%, and specificity 87.2%) but with overall lower PPVs than that reported by the NAPLS consortium. Three out of five of the identified clinical predictors for transition to psychosis from the NAPLS study were replicated in an independent s le. Using a combination of clinical variables the predictive validity of determining whether a UHR in idual develops a psychotic disorder was improved above UHR criteria alone. Although psychosis prediction is improved using this model, the probability of a person not developing psychotic disorder is still quite high at 35%.
Moving beyond the weight-loss paradigm of exercise interventions for mental illness
Publisher: Elsevier BV
Date: 12-2016
Psychotic symptoms with sexual content in the ultra high risk for psychosis population: Frequency and association with sexual trauma
Publisher: Elsevier BV
Date: 05-2010
DOI: 10.1016/J.PSYCHRES.2010.02.011
Abstract: In iduals at "ultra high risk" (UHR) for psychosis have been found to experience high rates of sexual trauma. An aetiological role for sexual trauma has been proposed for psychotic disorders and may influence psychotic symptom content. We aimed to investigate the relationship between previous sexual trauma and reported psychotic-like experiences, in particular psychotic symptoms with a sexual content in a UHR s le. We investigated the prevalence of "attenuated" or "subthreshold" psychotic symptoms with a sexual content in a consecutive series of patients recruited to a specialist UHR clinic. Patient's experience of general and sexual trauma was rated separately using a trauma questionnaire based on the list of events qualifying as traumas under DSM IV. The s le consisted of 92 patients, 14 (15.2%) had experienced an attenuated psychotic symptom with sexual content. The most common symptom was overvalued ideas/delusions of being watched in the shower/toilet or undressing. A considerable proportion of the s le (36.2%) had experienced sexual trauma (sexually molested or raped). Presence of attenuated psychotic symptoms with sexual content was related to history of previous sexual trauma (OR 7.17, P<0.01). This relationship remained significant when other traumatic experiences, PTSD diagnosis, age and sex were adjusted for. Further research into this relationship with regard to outcome and treatment is warranted.
Antipsychotic drugs versus cognitive behavioural therapy versus a combination of both in people with psychosis: a randomised controlled pilot and feasibility study
Publisher: Elsevier BV
Date: 05-2018
A clinical trials agenda for testing interventions in earlier stages of psychotic disorders
Publisher: AMPCo
Date: 02-2009
DOI: 10.5694/J.1326-5377.2009.TB02372.X
Abstract: A fundamental shift in the design of clinical trials for psychotic disorders is desirable and feasible. Priority should be placed on evaluation of the efficacy of interventions targeting different phases of illness. A range of traditional therapeutic approaches needs to be augmented by an increased emphasis on the potential benefits of informational, e-health, behavioural and neuroprotective strategies. A new national clinical trials platform, based on headspace, the National Youth Mental Health Foundation, is outlined. It provides the opportunity for conducting large multisite clinical trials in young people with emerging major mental disorders.
THE PSYCHOSIS HIGH RISK STATE: IS IT VALID?
Publisher: Elsevier BV
Date: 04-2014
Metacognitive beliefs in the at-risk mental state: A systematic review and meta-analysis
Publisher: Elsevier BV
Date: 03-2017
DOI: 10.1016/J.BRAT.2016.12.004
Abstract: Dysfunctional metacognitive beliefs are common among people with psychosis. In this meta-analysis we examined whether these are also present in people meeting at-risk mental state (ARMS) criteria. We also explored the relationship between metacognitive beliefs and symptoms in the ARMS group. An electronic database search of Ovid MEDLINE, PsycINFO and Embase from inception until August 2016 was conducted using keyword search terms synonymous with ARMS and metacognition. Eligible studies were original research articles that examined metacognitive beliefs using the Metacognitions Questionnaire (MCQ) among people meeting ARMS criteria. Studies included in the meta-analyses also reported comparison MCQ data acquired from healthy controls, help-seeking in iduals, or people with psychotic disorders. Eleven eligible studies were identified, reporting data from six unique ARMS s les. People with ARMS did not differ from those with established psychotic disorders on any MCQ subscale, but they reported significantly more dysfunctional metacognitive beliefs than healthy or help-seeking controls. Maladaptive metacognitive beliefs were associated with a range of symptoms in ARMS in iduals, but evidence for associations with specific subthreshold psychotic phenomena was inconsistent. This evidence indicates how valuable assessment and treatment of dysfunctional metacognitive beliefs may be but suggests that specific aspects of methodology should be addressed.
Neuroanatomical Abnormalities That Predate the Onset of Psychosis
Publisher: American Medical Association (AMA)
Date: 02-05-2011
DOI: 10.1001/ARCHGENPSYCHIATRY.2011.42
Abstract: People experiencing possible prodromal symptoms of psychosis have a very high risk of developing the disorder, but it is not possible to predict, on the basis of their presenting clinical features, which in iduals will subsequently become psychotic. Recent neuroimaging studies suggest that there are volumetric differences between in iduals at ultra-high risk (UHR) for psychosis who later develop psychotic disorder and those who do not. However, the s les examined to date have been small, and the findings have been inconsistent. To assess brain structure in in iduals at UHR for psychosis in a larger and more representative s le than in previous studies by combining magnetic resonance imaging data from 5 different scanning sites. Case-control study. Multisite. A total of 182 in iduals at UHR and 167 healthy controls. Participants were observed clinically for a mean of 2 years. Forty-eight in iduals (26.4%) in the UHR group developed psychosis and 134 did not. Magnetic resonance images were acquired from each participant. Group differences in gray matter volume were examined using optimized voxel-based morphometry. The UHR group as a whole had less gray matter volume than did controls in the frontal regions bilaterally. The UHR subgroup who later developed psychosis had less gray matter volume in the left parahippoc al cortex than did the UHR subgroup who did not. In iduals at high risk for psychosis show alterations in regional gray matter volume regardless of whether they subsequently develop the disorder. In the UHR population, reduced left parahippoc al volume was specifically associated with the later onset of psychosis. Alterations in this region may, thus, be crucial to the expression of illness. Identifying abnormalities that specifically predate the onset of psychosis informs the development of clinical investigations designed to predict which in iduals at high risk will subsequently develop the disorder.
Biomarkers and clinical staging in psychiatry
Publisher: Wiley
Date: 10-2014
DOI: 10.1002/WPS.20144
A pilot randomised controlled trial comparing antipsychotic medication, to cognitive behavioural therapy to a combination of both in people with psychosis: rationale, study design and baseline data of
Publisher: Informa UK Limited
Date: 11-05-2017
Improving Collaboration Between Private Psychiatrists, the Public Mental Health Sector and General Practitioners: Evaluation of the Partnership Project
Publisher: SAGE Publications
Date: 03-2004
DOI: 10.1080/J.1440-1614.2004.01314.X
Abstract: Objectives: We describe the evaluation of the Partnership Project, which was designed to improve linkages between public and private sector mental health services. We consider the Project's key elements: a Linkage Unit, designed to improve collaborative arrangements for consumers and promote systems-level and cultural change and the expansion of private psychiatrists' roles to include supervision and training, case conferencing and secondary consultation. The evaluation aimed to describe the impacts and outcomes of these elements. Method: The evaluation used de-identified data from the Linkage Unit database, the Project's billing system, and the Health Insurance Commission (HIC). It drew on consultations with key stakeholders (semistructured interviews with 36 key informants, and information from a forum attended by over 40 carers and a meeting of five public sector and three private sector psychiatrists) and a series of case studies. Results: The Linkage Unit facilitated 224 episodes of collaborative care, many of which had positive outcomes for providers, consumers and carers. It had a significant impact at a systems level, raising consciousness about collaboration and influencing procedural changes. Thirty-two private psychiatrists consented to undertaking expanded roles, and the Project was billed $78 032 accordingly. Supervision and training were most common, involving 16 psychiatrists and accounting for approximately 80% of the total hours and cost. Commonwealth expenditure on private psychiatrists' participation in the expanded roles was not associated with a reduction in benefits paid by the HIC. Key informants were generally positive about the expanded roles. Conclusions: The Project represented a considered, innovative approach to dealing with poor collaboration between the public mental health sector, private psychiatrists and GPs. The Linkage Unit achieved significant systems-level and cultural change, which has the potential to be sustained. Expanded roles for private psychiatrists, particularly supervision and training, may improve collaboration, and warrant further exploration in terms of costs and benefits.
Randomized Controlled Trial of Interventions for Young People at Ultra High Risk for Psychosis
Publisher: Physicians Postgraduate Press, Inc
Date: 19-10-2010
Impairment of olfactory identification ability in individuals at ultra-high risk for psychosis who later develop schizophrenia
Publisher: American Psychiatric Association Publishing
Date: 10-2003
DOI: 10.1176/APPI.AJP.160.10.1790
Abstract: Previous investigation has revealed stable olfactory identification deficits in neuroleptic-naive patients experiencing a first episode of psychosis, but it is unknown if these deficits predate illness onset. The olfactory identification ability of 81 patients at ultra-high risk for psychosis was examined in relation to that of 31 healthy comparison subjects. Twenty-two of the ultra-high-risk patients (27.2%) later became psychotic, and 12 of these were diagnosed with a schizophrenia spectrum disorder. There was a significant impairment in olfactory identification ability in the ultra-high-risk group that later developed a schizophrenia spectrum disorder but not in any other group. These findings suggest that impairment of olfactory identification is a premorbid marker of transition to schizophrenia, but it is not predictive of psychotic illness more generally.
A randomised controlled trial of interventions in the pre-psychotic phase of psychotic disorders
Publisher: Elsevier BV
Date: 2000
Selective bias in criticism of early intervention
Publisher: SAGE Publications
Date: 09-2012
Investigating the Agreement Between Cardiovascular Disease Risk Calculators Among People Diagnosed With Schizophrenia
Publisher: Frontiers Media SA
Date: 12-12-2018
Developing Partnerships Between Public and Private Psychiatry
Publisher: SAGE Publications
Date: 12-2000
Childhood trauma and functional disability in psychosis, bipolar disorder and borderline personality disorder: a review of the literature
Publisher: Cambridge University Press (CUP)
Date: 10-12-2014
DOI: 10.1017/IPM.2014.74
Abstract: We aimed to examine the association between childhood trauma and functional impairment in psychotic disorders, bipolar disorder and borderline personality disorder, to speculate on possible mechanisms that underlie this association and discuss the implications for clinical work. Narrative review of the peer-reviewed English language literature in the area. High rates of childhood trauma in psychotic disorders, bipolar disorder and borderline personality disorder were identified. This was associated with impaired social and occupational functioning in both the premorbid and established phases of each of these psychiatric disorders over and above the deficits typically observed in these populations. Possible mechanisms mediating this relationship include neurocognitive deficits, insecure attachment, higher rates of comorbidities and problems with adherence and response to treatment. Routine clinical inquiry about childhood maltreatment should be adopted within mental health settings. This has potentially important treatment implications for identifying those in iduals at elevated risk of functional disability. While there is no clear guidance currently available on how to target childhood trauma in the treatment of psychotic disorders, bipolar disorder or borderline personality disorder, there are several promising lines of enquiry and further research is warranted.
Depressed mood as a risk factor for unprotected sex in young people
Publisher: SAGE Publications
Date: 09-2006
Cannabis-induced attenuated psychotic symptoms: implications for prognosis in young people at ultra-high risk for psychosis
Publisher: Cambridge University Press (CUP)
Date: 08-11-2016
DOI: 10.1017/S0033291716002671
Abstract: Cannabis use shows a robust dose-dependent relationship with psychosis risk among the general population. Despite this, it has been difficult to link cannabis use with risk for transitioning to a psychotic disorder among in iduals at ultra-high risk (UHR) for psychosis. The present study examined UHR transition risk as a function of cannabis use characteristics which vary substantially between in iduals including age of first use, cannabis abuse severity and a history of cannabis-induced attenuated psychotic symptoms (APS). Participants were 190 UHR in iduals (76 males) recruited at entry to treatment between 2000 and 2006. They completed a comprehensive baseline assessment including a survey of cannabis use characteristics during the period of heaviest use. Outcome was transition to a psychotic disorder, with mean time to follow-up of 5.0 years (range 2.4–8.7 years). A history of cannabis abuse was reported in 58% of the s le. Of these, 26% reported a history of cannabis-induced APS. These in iduals were 4.90 (95% confidence interval 1.93–12.44) times more likely to transition to a psychotic disorder ( p = 0.001). Greater severity of cannabis abuse also predicted transition to psychosis ( p = 0.036). However, this effect was mediated by higher abuse severity among in iduals with a history of cannabis-induced APS. Findings suggest that cannabis use poses risk in a subpopulation of UHR in iduals who manifest cannabis-induced APS. Whether this reflects underlying genetic vulnerability requires further study. Nevertheless, findings reveal an important early marker of risk with potentially significant prognostic utility for UHR in iduals.
Dynamic prediction of transition to psychosis using joint modelling
Publisher: Elsevier BV
Date: 12-2018
DOI: 10.1016/J.SCHRES.2018.07.002
Abstract: Considerable research has been conducted seeking risk factors and constructing prediction models for transition to psychosis in in iduals at ultra-high risk (UHR). Nearly all such research has only employed baseline predictors, i.e. data collected at the baseline time point, even though longitudinal data on relevant measures such as psychopathology have often been collected at various time points. Dynamic prediction, which is the updating of prediction at a post-baseline assessment using baseline and longitudinal data accumulated up to that assessment, has not been utilized in the UHR context. This study explored the use of dynamic prediction and determined if it could enhance the prediction of frank psychosis onset in UHR in iduals. An emerging statistical methodology called joint modelling was used to implement the dynamic prediction. Data from the NEURAPRO study (n = 304 UHR in iduals), an intervention study with transition to psychosis study as the primary outcome, were used to investigate dynamic predictors. Compared with the conventional approach of using only baseline predictors, dynamic prediction using joint modelling showed significantly better sensitivity, specificity and likelihood ratios. As dynamic prediction can provide an up-to-date prediction for each in idual at each new assessment post entry, it can be a useful tool to help clinicians adjust their prognostic judgements based on the unfolding clinical symptomatology of the patients. This study has shown that a dynamic approach to psychosis prediction using joint modelling has the potential to aid clinicians in making decisions about the provision of timely and personalized treatment to patients concerned.
The EMPOWER blended digital intervention for relapse prevention in schizophrenia: a feasibility cluster randomised controlled trial in Scotland and Australia
Publisher: Elsevier BV
Date: 06-2022
Early intervention in psychosis: evidence, evidence gaps, criticism, and confusion
Publisher: SAGE Publications
Date: 2012
Externalized attributional bias in the Ultra High Risk (UHR) for psychosis population
Publisher: Elsevier BV
Date: 04-2013
DOI: 10.1016/J.PSYCHRES.2012.10.017
Abstract: Specific externalizing attributional biases appear to be common in early psychosis. They may represent trait risk factors for the later development of a psychotic disorder, yet few studies have investigated this in clinical "at risk" populations. We aimed to investigate one particular bias, the Locus of Control of reinforcement (LOC) in a "Ultra High Risk" (UHR) for psychosis group. We recruited UHR in iduals from an established at risk clinical service and a community control group. LOC was measured using the Adult Nowicki Strickland Internal External scale (ANSIE). Neuropsychological functioning, social functioning and psychopathology were assessed. We analyzed data from 30 controls and 30 UHR in iduals. The UHR s le had a significantly more externalized LOC (control for events perceived to be external to the person) than controls. This difference remained statistically significant after adjusting for covariates (age, gender and IQ). More externalized LOC scores were negatively correlated with social and occupational functioning scores in the control group but not in the UHR group and positively correlated with negative symptoms and paranoid symptoms in the UHR group. These findings have implications for identifying potential psychological vulnerabilities for the development of psychosis and informing treatment approaches within the at risk group.
A systematic review and meta-analysis of exercise interventions in schizophrenia patients
Publisher: Cambridge University Press (CUP)
Date: 04-02-2015
DOI: 10.1017/S0033291714003110
Abstract: The typically poor outcomes of schizophrenia could be improved through interventions that reduce cardiometabolic risk, negative symptoms and cognitive deficits aspects of the illness which often go untreated. The present review and meta-analysis aimed to establish the effectiveness of exercise for improving both physical and mental health outcomes in schizophrenia patients. We conducted a systematic literature search to identify all studies that examined the physical or mental effects of exercise interventions in non-affective psychotic disorders. Of 1581 references, 20 eligible studies were identified. Data on study design, s le characteristics, outcomes and feasibility were extracted from all studies and systematically reviewed. Meta-analyses were also conducted on the physical and mental health outcomes of randomized controlled trials. Exercise interventions had no significant effect on body mass index, but can improve physical fitness and other cardiometabolic risk factors. Psychiatric symptoms were significantly reduced by interventions using around 90 min of moderate-to-vigorous exercise per week (standardized mean difference: 0.72, 95% confidence interval −1.14 to −0.29). This amount of exercise was also reported to significantly improve functioning, co-morbid disorders and neurocognition. Interventions that implement a sufficient dose of exercise, in supervised or group settings, can be feasible and effective interventions for schizophrenia.
Childhood maltreatment and transition to psychotic disorder independently predict long-term functioning in young people at ultra-high risk for psychosis
Publisher: Cambridge University Press (CUP)
Date: 13-07-2015
DOI: 10.1017/S003329171500135X
Abstract: In iduals identified as at ultra-high risk (UHR) for psychosis are at risk of poor functional outcome regardless of development of psychotic disorder. Studies examining longitudinal predictors of poor functioning have tended to be small and report only medium-term follow-up data. We sought to examine clinical predictors of functional outcome in a long-term longitudinal study. Participants were 268 (152 females, 116 males) in iduals identified as UHR 2–14 years previously. A range of clinical and sociodemographic variables were assessed at baseline. Functioning at follow-up was assessed using the Social and Occupational Functioning Assessment Scale (SOFAS). Baseline negative symptoms, impaired emotional functioning, disorders of thought content, low functioning, past substance use disorder and history of childhood maltreatment predicted poor functioning at follow-up in univariate analyses. Only childhood maltreatment remained significant in the multivariate analysis ( p 0.001). Transition to psychosis was also significantly associated with poor functioning at long-term follow-up [mean SOFAS score 59.12 ( s.d. = 18.54) in the transitioned group compared to 70.89 ( s.d. = 14.00) in the non-transitioned group, p 0.001]. Childhood maltreatment was a significant predictor of poor functioning in both the transitioned and non-transitioned groups. Childhood maltreatment and transition to psychotic disorder independently predicted poor long-term functioning. This suggests that it is important to assess history of childhood maltreatment in clinical management of UHR in iduals. The finding that transition to psychosis predicts poor long-term functioning strengthens the evidence that the UHR criteria detect a subgroup at risk for schizophrenia.
Social Functioning Deficits in Young People at Risk for Schizophrenia
Publisher: SAGE Publications
Date: 2008
DOI: 10.1080/00048670802203459
Abstract: Objective: Impairment in social functioning is a central feature of schizophrenia and is known to be evident before the onset of psychosis, acting as a potential vulnerability marker. The aim of the present study was to test the hypothesis that social impairment is simultaneously a state and trait marker of risk for schizophrenia and schizophrenia-related disorder. Method: Social functioning was examined in three groups: ultra-high-risk subjects (UHR, n =32), genetic high-risk subjects (GHR, n =32), and age- and IQ-matched healthy controls (HC, n =30). Social functioning was assessed using the Social Functioning Scale (SFS), and prodromal symptoms were assessed in high-risk subjects using the Comprehensive Assessment of At-Risk Mental States (CAARMS). Results: Both the UHR and GHR groups exhibited significantly impaired social functioning compared with the HC group, and the UHR group was more impaired than the GHR group. In the UHR group, duration of prodromal symptoms was related to impaired ‘interpersonal behaviour’. Positive and negative symptoms were not significantly associated with social functioning, whereas disorganized and general symptoms were significantly correlated with poor ‘independence–competence’ in UHR in iduals. Conclusion: The findings support the hypothesis that impairment in social functioning is both a trait and state marker of risk for schizophrenia and other psychotic disorders, implying that social impairment constitutes a mediating vulnerability indicator of psychotic disorders including schizophrenia.
Early identification and intervention in depressive disorders: Towards a clinical staging model
Publisher: S. Karger AG
Date: 2008
DOI: 10.1159/000140085
Abstract: i Background: /i Depressive disorders are common and associated risks include the onset of secondary disorders, substance use disorders, impairment in social and occupational functioning, and an increase in suicidality. As the onset often occurs in youth, there is a clear imperative for early identification and intervention to ameliorate, if not prevent, associated distress. i Methods: /i An extensive search of relevant databases and an ancestry search was undertaken. i Results: /i There is a limited but growing body of literature on this topic that is discussed in relation to a clinical staging model, which may prove to be a useful framework for identifying where an in idual lies along the continuum of the course of a depressive illness thus allowing interventions to be matched for that stage. The identification of a subsyndromal and prodromal stage of depressive disorders provides early intervention opportunities. i Conclusions: /i It is argued that a clinical staging heuristic may increase the number of those treated early, which may in turn delay or prevent onset, reduce severity, or prevent progression in the course of depressive disorders.
Cognitive and olfactory deficits: Course from high risk to first-episode psychosis
Publisher: Elsevier BV
Date: 1998
WHY TRANSITION TO PSYCHOSIS IS NOT THE WHOLE STORY - NEUROCOGNITIVE MARKERS OF TRANSITION AND POOR FUNCTIONAL OUTCOME SEVEN TO 14 YEARS AFTER IDENTIFICATION AS ULTRA-HIGH RISK AT THE PACE CLINIC
Publisher: Elsevier BV
Date: 04-2010
Global research priorities for youth mental health
Publisher: Wiley
Date: 20-01-2020
DOI: 10.1111/EIP.12878
Abstract: Over the past two decades, the youth mental health field has expanded and advanced considerably. Yet, mental disorders continue to disproportionately affect adolescents and young adults. Their prevalence and associated morbidity and mortality in young people have not substantially reduced, with high levels of unmet need and poor access to evidence-based treatments even in high-income countries. Despite the potential return on investment, youth mental disorders receive insufficient funding. Motivated by these continual disparities, we propose a strategic agenda for youth mental health research. Youth mental health experts and funders convened to develop youth mental health research priorities, via thematic roundtable discussions, that address critical evidence-based gaps. Twenty-one global youth mental health research priorities were developed, including population health, neuroscience, clinical staging, novel interventions, technology, socio-cultural factors, service delivery, translation and implementation. These priorities will focus attention on, and provide a basis for, a systematic and collaborative strategy to globally improve youth mental health outcomes.
Can youth at high risk of illness progression be identified by measures of rumination and sleep-wake disturbance.
Publisher: Wiley
Date: 28-11-2019
DOI: 10.1111/EIP.12757
Abstract: Clinical staging models offer a useful framework for understanding illness trajectories, where in iduals are located on a continuum of illness progression from stage 0 (at-risk but asymptomatic) to stage 4 (end-stage disease). Importantly, clinical staging allows investigation of risk factors for illness progression with the potential to target trans-diagnostic mechanisms at an early stage, especially in help-seeking youth who often present with sub-threshold syndromes. While depressive symptoms, rumination and sleep-wake disturbances may worsen syndrome outcomes, the role of these related phenomena has yet to be examined as risk factors for trans-diagnostic illness progression in at-risk youth. This study is a prospective follow-up of 248 in iduals aged 12 to 25 years presenting to headspace services with sub-threshold syndromes (stage 1) classified under the clinical staging model to determine transition to threshold syndromes (stage 2). Factor analysis of depression, rumination and sleep-wake patterns was used to identify key dimensions and any associations between factors and transition to stage 2 at follow-up. At 1 year, 9% of cases met criteria for stage 2 (n = 22). One of three identified factors, namely the factor reflecting the commonalities shared between rumination and sleep-wake disturbance, significantly differentiated cases that transitioned to stage 2 vs those that did not demonstrate transition. Items loading onto this factor, labelled Anergia, included depression severity and aspects of rumination and sleep-wake disturbance that were characterized as introceptive. Common dimensions between rumination and sleep-wake disturbance present a detectable trans-diagnostic marker of illness progression in youth, and may represent a target for early intervention.
Youth services: the need to integrate mental health, physical health and social care
Publisher: Springer Science and Business Media LLC
Date: 03-2016
DOI: 10.1007/S00127-016-1195-6
Abstract: Mental distress and mental health disorders are common in young people. Indeed, over 75 % of mental disorders begin before the age of 25 years. Long delays in seeking help for illnesses are common, initial intervention is often ineffective and young people are at risk of disengaging with treatment, particularly when they are expected to move from child and adolescent treating teams to adult services. All of these factors mean that young people are vulnerable to prolonged mental ill-health and its consequences, including educational failure, unemployment, social disengagement and deprivation, and development of further mental health problems including substance misuse. Malla et al. present different service models that attempt to address these issues. Additionally, there needs to be a focus on physical health and social care as these are intertwined with mental health.
Early intervention in psychosis: Concepts, evidence and future directions
Publisher: Wiley
Date: 10-2008
DOI: 10.1002/J.2051-5545.2008.TB00182.X
Abstract: The rise of the early intervention paradigm in psychotic disorders represents a maturing of the therapeutic approach in psychiatry, as it embraces practical preventive strategies which are firmly established in mainstream health care. Early intervention means better access and systematic early delivery of existing and incremental improvements in knowledge rather than necessarily requiring dramatic and elusive breakthroughs. A clinical staging model has proven useful and may have wider utility in psychiatry. The earliest clinical stages of psychotic disorder are non-specific and multidimensional and overlap phenotypically with the initial stages of other disorders. This implies that treatment should proceed in a stepwise fashion depending upon safety, response and progression. Withholding treatment until severe and less reversible symptomatic and functional impairment have become entrenched represents a failure of care. While early intervention in psychosis has developed strongly in recent years, many countries have made no progress at all, and others have achieved only sparse coverage. The reform process has been substantially evidence-based, arguably more so than other system reforms in mental health. However, while evidence is necessary, it is insufficient. It is also a by-product as well as a catalyst of reform. In early psychosis, we have also seen the evidence-based paradigm misused to frustrate overdue reform. Mental disorders are the chronic diseases of the young, with their onset and maximum impact in late adolescence and early adult life. A broader focus for early intervention would solve many of the second order issues raised by the early psychosis reform process, such as diagnostic uncertainty despite a clear-cut need for care, stigma and engagement, and should be more effective in mobilizing community support. Early intervention represents a vital and challenging project for early adopters in global psychiatry to consider.
Letter to the editor
Publisher: Cambridge University Press (CUP)
Date: 04-03-2011
Opening the Black Box of Cognitive-Behavioural Case Management in Clients with Ultra-High Risk for Psychosis
Publisher: S. Karger AG
Date: 2017
DOI: 10.1159/000477551
Abstract: b i Background: /i /b Cognitive-behavioural therapy (CBT) is the first-choice treatment in clients with ultra-high risk (UHR) for psychosis. However, CBT is an umbrella term for a plethora of different strategies, and little is known about the association between the intensity and content of CBT and the severity of symptomatic outcome. b i Methods: /i /b A s le of 268 UHR participants received 6 months of CBT with case management (CBCM) in the context of the multi-centre NEURAPRO trial with monthly assessments of attenuated psychotic symptoms (APS). Using multilevel regressions and controlling for the initial severity of APS, the associations between (1) number of CBCM sessions received and severity of APS and (2) specific CBCM components and severity of APS were investigated. b i Results: /i /b In month 1, a higher number of sessions and more assessment of symptoms predicted an increase in APS, while in month 3, a higher number of sessions and more monitoring predicted a decrease in the level of APS. More therapeutic focus on APS predicted an overall increase in APS. b i Conclusions: /i /b Our findings indicate that the association between intensity/content of CBCM and severity of APS in a s le of UHR participants depends on the length of time in treatment. CBCM may positively impact the severity of APS later in the course of treatment. Therefore, it would seem important to keep UHR young people engaged in treatment beyond this initial period. Regarding the specific content of CBCM, a therapeutic focus on APS may not necessarily be beneficial in reducing the severity of APS, a possibility in need of further investigation.
HPA-axis functioning and the onset of psychosis in a high-risk group: Preliminary investigations
Publisher: Elsevier BV
Date: 03-2003
Lifestyle factors may be linked to symptoms of metabolic syndrome in people at risk for psychosis
Publisher: Elsevier BV
Date: 05-2017
The phenomenological critique and self-disturbance: Implications for ultra-high risk (Prodrome) research
Publisher: Oxford University Press (OUP)
Date: 09-04-2008
Should a Risk Syndrome for Psychosis be included in the DSMV?
Publisher: Elsevier BV
Date: 07-2010
DOI: 10.1016/J.SCHRES.2010.03.017
Abstract: The proposed Risk Syndrome for Psychosis (RS) criteria are derived from the Ultra High Risk criteria (UHR) and prodromal or Clinical High Risk criteria (CHR), and consist of subthreshold or attenuated positive psychotic symptoms with operationalized recency and frequency criteria. The rationale behind the proposed inclusion of the RS in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSMV) is that several studies have found that the UHR rodromal/CHR criteria predict onset of psychotic disorder, mainly schizophrenia, within a brief time period of a few years. Identifying in iduals meeting these criteria thus affords the possibility of early intervention to prevent or delay onset of full blown psychotic disorder. However, the RS is yet to be properly validated. Additionally, there are potential dangerous unintended consequences of the reification of this syndrome as a formal diagnosis. Thus we feel it is premature to justify inclusion of the RS in the DSM.
Neighbourhood characteristics and the rate of identification of young people at ultra-high risk for psychosis
Publisher: Elsevier BV
Date: 12-2015
DOI: 10.1016/J.SCHRES.2015.09.002
Abstract: There is a higher incidence of psychotic disorders in more socially deprived neighbourhoods and a higher risk in migrants living in neighbourhoods of low ethnic density. Yet it is unclear at what stage these neighbourhood environmental factors exert an influence on the risk for psychosis. 166 Ultra high risk for psychosis young people were included in this study. Neighbourhood data were obtained from the Australian Bureau of Statistics. There was a trend for UHR in iduals to reside in relatively more deprived areas and there was no association between the rate of identification of UHR migrants and neighbourhood ethnic density.
Can receipt of a regular postcard reduce suicide-related behaviour in young help seekers? A randomized controlled trial
Publisher: Wiley
Date: 19-01-2012
DOI: 10.1111/J.1751-7893.2011.00334.X
Abstract: Suicide attempt, ideation and deliberate self-harm are common among adolescents. Limited evidence exists regarding interventions that can reduce risk however, research indicates that maintaining contact with at-risk adults following discharge from services via letter or postcard can reduce risk. The aim of the study was to test a postcard intervention among people aged 15-24 who presented to mental health services but were not accepted, yet were at risk of suicide. A randomized controlled trial of 3 years in duration was used. The intervention consisted of 12 postcards sent once a month for 12 months following presentation to the service. Key outcomes of interest were reduced rates of suicide attempt, suicidal ideation and deliberate self-harm, assessed at 12 and 18 months. Participants reported that they liked receiving the postcard and that they used the strategies recommended. However, no significant effect of the postcard intervention was found on suicide risk, although participants in both groups improved on measures of mental health over the course of the study. There remains a need for further research into youth-friendly interventions for young people at risk of suicide.
The psychosis threshold in Ultra High Risk (prodromal) research: Is it valid?
Publisher: Elsevier BV
Date: 07-2010
DOI: 10.1016/J.SCHRES.2010.03.014
Abstract: "Transition to psychosis" has been the outcome of interest in Ultra High Risk (UHR) and "prodromal" studies. However, the point at which an in idual crosses the line from high risk or prodromal state to psychosis threshold is arbitrary. There have been few attempts to examine whether this threshold has any validity in terms of biological markers or course and outcome. More research is needed to determine if the current point at which a person is declared "psychotic" is valid. Indeed some persons labeled as having developed psychosis may quickly recover. In such a situation their transition could be seen as "trivial". Others who do not make "transition" may have worse outcomes. Validation of the transition point is an important issue as "risk syndrome for psychosis" (psychosis prodrome) is being considered for inclusion in the DSMV. Further, much research attempts to distinguish markers for psychotic disorders by examining the differences between UHR in iduals who do and do not develop psychosis. Thus it behooves us not just to have this risk syndrome validated, but to have the hypothetical endpoint of psychosis validated as well.
Examining healthcare professionals’ beliefs and actions regarding the physical health of people with schizophrenia
Publisher: Springer Science and Business Media LLC
Date: 20-08-2020
DOI: 10.1186/S12913-020-05654-Z
Abstract: People with schizophrenia have a higher premature mortality risk compared with the general population mainly due to cardiovascular disease (CVD). Despite this, people with schizophrenia are less likely to access physical health services or have their physical health investigated and monitored. To examine the beliefs and actions of mental health professionals regarding the physical health of people with schizophrenia. Two hundred and fifty-five healthcare professionals who support people with schizophrenia within Greater Manchester Mental Health NHS Foundation Trust (GMMH), United Kingdom and Pennine Care NHS Foundation Trust (PCFT), United Kingdom took part. Beliefs and actions were assessed using a self-administered questionnaire, which was constructed around two primary domains (1) CVD risk factors and (2) physical health interventions. Descriptive statistics were reported and responses between different healthcare professional groups were compared. The overwhelming majority of participants were aware of established CVD risk factors with 98% identifying family history of CVD, 98% for smoking and 96% for high blood pressure. Most participants believed nearly all healthcare professionals were responsible for monitoring the physical health of people with schizophrenia, regardless of job speciality. There were 67% of participants who reported delivering an intervention to improve sedentary behaviour for people with schizophrenia. However, awareness of government and NHS recommended lifestyle interventions were low. This study found good knowledge regarding many established CVD risk factors but little clarity regarding who is responsible for monitoring the physical health of people with schizophrenia and how often brief lifestyle interventions are being implemented.
Neurocognition as a predictor of transition to psychotic disorder and functional outcomes in ultra-high risk participants: Findings from the NEURAPRO randomized clinical trial
Publisher: Elsevier BV
Date: 04-2019
DOI: 10.1016/J.SCHRES.2018.12.013
Abstract: Neurocognitive impairments experienced by in iduals at ultra-high risk (UHR) for psychosis are potential predictors of outcome within this population, however there is inconsistency regarding the specific neurocognitive domains implicated. This study aimed to examine whether baseline neurocognition predicted transition to psychosis, or functional outcomes, at medium-term (mean = 3.4 years) follow-up, while controlling for other clinical/treatment variables associated with transition to psychosis. Analysis of data collected as part of a multi-centre RCT of omega-3 fatty acids and cognitive-behavioural case management (NEURAPRO) for UHR in iduals was conducted on the 294 participants (134 males, 160 females) who completed neurocognitive assessment (Brief Assessment of Cognition for Schizophrenia) at baseline. Transition to psychosis was determined using the Comprehensive Assessment of At-Risk Mental States (CAARMS), and functioning was measured with the Global Functioning: Social and Role Scales. Mean baseline z-scores indicated that UHR participants performed a quarter to half a standard deviation below normative means in all domains (range mean z = -0.24 to -0.47), except for executive functioning (mean z = 0.16). After adjusting for covariates, poorer Executive (p = .010) and Motor (p = .030) functions were predictive of transition to psychosis. Processing Speed and Verbal Fluency were significant predictors of role functioning at 12 months (p = .004), and social functioning at medium-term follow-up (p = .015), respectively. Neurocognitive abilities are independent predictors of both transition to psychosis and functional outcomes within the UHR population. Further research is needed to determine the best combination of risk variables in UHR in iduals for prediction of psychosis transition, functioning and other psychopathology outcomes.
Pre-psychotic intervention in schizophrenia: A stitch in time?
Publisher: Elsevier BV
Date: 1998
Pituitary volume predicts future transition to psychosis in individuals at ultra-high risk of developing psychosis
Publisher: Elsevier BV
Date: 09-2005
DOI: 10.1016/J.BIOPSYCH.2005.04.018
Abstract: We examined pituitary volume before the onset of psychosis in subjects who were at ultra-high risk (UHR) for developing psychosis. Pituitary volume was measured on 1.5-mm, coronal, 1.5-T magnetic resonance images in 94 UHR subjects recruited from admissions to the Personal Assessment and Crisis Evaluation Clinic in Melbourne, Australia and in 49 healthy control subjects. The UHR subjects were scanned at baseline and were followed clinically for a minimum of 1 year to detect transition to psychosis. Within the UHR group, a larger baseline pituitary volume was a significant predictor of future transition to psychosis. The UHR subjects who later went on to develop psychosis (UHR-P, n = 31) had a significantly larger (+12% p = .001) baseline pituitary volume compared with UHR subjects who did not go on to develop psychosis (UHR-NP, n = 63). The survival analysis conducted by Cox regression showed that the risk of developing psychosis during the follow-up increased by 20% for every 10% increase in baseline pituitary volume (p = .002). Baseline pituitary volume of the UHR-NP subjects was smaller not only compared with UHR-P (as described above) but also compared with control subjects (-6% p = .032). The phase before the onset of psychosis is associated with a larger pituitary volume, suggesting activation of the HPA axis.
HISTORY OF TRAUMA IN THE ULTRA HIGH RISK FOR PSYCHOSIS POPULATION: FINDINGS FROM THE PACE CLINIC
Publisher: Elsevier BV
Date: 04-2014
The Longitudinal Association of Adolescent Dating Violence With Psychiatric Disorders and Functioning
Publisher: SAGE Publications
Date: 19-12-2008
Abstract: While the prevalence, correlates and mental health impacts of intimate partner violence are well documented in adolescents and young adults, fewer studies have considered physical dating violence among clinical s les of help-seeking young people. In a s le of 98 young people aged 15-24 years (54% females) referred to a specialist public youth mental health service, we examined the 12-month prevalence of physical violence inflicted by an intimate partner and its relationship with psychiatric disorders and psychosocial functioning. The reported prevalence of dating violence in the 12 months prior to referral was 13%. Physical dating violence reported at referral was associated with poorer psychosocial functioning, substance dependence and comorbid Axis I diagnoses at 6-month follow-up. These findings suggest that youth mental health services are well positioned not only to screen for dating violence but to intervene to ameliorate the mental health consequences of abuse and to prevent further violence.
The effects of vitamin and mineral supplementation on symptoms of schizophrenia: A systematic review and meta-analysis
Publisher: Cambridge University Press (CUP)
Date: 16-02-2017
DOI: 10.1017/S0033291717000022
Abstract: When used as an adjunctive with antipsychotics, certain vitamins and minerals may be effective for improving symptomatic outcomes of schizophrenia, by restoring nutritional deficits, reducing oxidative stress, or modulating neurological pathways. We conducted a systematic review of all randomized controlled trials (RCTs) reporting effects of vitamin and/or mineral supplements on psychiatric symptoms in people with schizophrenia. Random-effects meta-analyses were used to calculate the standardized mean difference between nutrient and placebo treatments. An electronic database search in July 2016 identified 18 eligible RCTs, with outcome data for 832 patients. Pooled effects showed that vitamin B supplementation (including B6, B8 and B12) reduced psychiatric symptoms significantly more than control conditions [ g = 0.508, 95% confidence interval (CI) 0.01–1.01, p = 0.047, I 2 = 72.3%]. Similar effects were observed among vitamin B RCTs which used intention-to-treat analyses ( g = 0.734, 95% CI 0.00–1.49, p = 0.051). However, no effects of B vitamins were observed in in idual domains of positive and negative symptoms (both p 0.1). Meta-regression analyses showed that shorter illness duration was associated with greater vitamin B effectiveness ( p = 0.001). There were no overall effects from antioxidant vitamins, inositol or dietary minerals on psychiatric symptoms. There is preliminary evidence that certain vitamin and mineral supplements may reduce psychiatric symptoms in some people with schizophrenia. Further research is needed to examine how the benefits of supplementation relate to nutrient deficits and the impact upon underlying neurobiological pathways, in order to establish optimal nutrient formulations for improving clinical outcomes in this population. Future studies should also explore the effects of combining beneficial nutrients within multi-nutrient formulas.
LONG TERM FOLLOW UP OF AN ULTRA HIGH RISK (PRODROMAL) GROUP
Publisher: Elsevier BV
Date: 04-2010
Effectiveness of early intervention in psychosis
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2007
Validation of a short adaptation of the Mood and Anxiety Symptoms Questionnaire (MASQ) in adolescents and young adults
Publisher: Elsevier BV
Date: 03-2014
DOI: 10.1016/J.PSYCHRES.2013.12.018
Abstract: The Mood and Anxiety Symptoms Questionnaire (MASQ) was developed to measure the symptom-dimensions of the tripartite model of anxiety and depression. A 30-item short adaptation of the MASQ (MASQ-D30) was previously developed and validated in adult psychiatric outpatients. The aim of the present study was to evaluate the validity and reliability of the MASQ-D30 in a s le of adolescents and young adults. Help-seeking adolescents from Australia (N=147 mean age: 17.7 years 58.8% female) completed the original, 90-item MASQ. Confirmatory Factor Analysis (CFA) was used to evaluate the construct validity (a 3-factor structure) of the original MASQ and the MASQ-D30. Internal consistencies and correlations with other instruments were calculated and compared between versions. CFA showed that the intended 3-factor structure fit adequately to the MASQ-D30 data (CFI=0.95 RMSEA=0.08). Internal consistencies ranged from 0.85 to 0.92 across the scales and patterns of correlations with the Center for Epidemiological Studies-Depression (CES-D) indicated adequate convergent/ ergent properties. Importantly, the observed psychometric characteristics were comparable with the original MASQ and alternative short-forms. Results indicated that the MASQ-D30 is a valid and reliable instrument in young people, allowing for quick assessment of the tripartite dimensions of depression and anxiety.
Psychotic-like experiences and correlation with distress and depressive symptoms in a community sample of adolescents and young adults
Publisher: Elsevier BV
Date: 06-2010
DOI: 10.1016/J.SCHRES.2010.03.001
Abstract: Studies conducted in community s les indicate that psychotic-like experiences (PLEs) are common in the general population it has been suggested that such experiences are either variations in normal personality or different expressions of vulnerability to psychotic disorders. The aim of this study was to determine whether different subtypes of PLEs could be identified in a community s le of adolescents and young adults, and to investigate whether particular subtypes of PLEs were more likely to be associated with psychosocial difficulties, i.e. distress, depression and poor functioning, than other subtypes. 1882 students from high schools and universities participated in a cross-sectional multisite survey that measured i) PLEs using the Positive Scale of the Community Assessment of Psychic Experiences (CAPE), ii) depression and distress using the CAPE Depression and Distress Subscales, and iii) functioning using the General Health Questionnaire-12. Factor analysis was conducted to identify any subtypes of PLEs. Four subtypes of PLEs were identified: bizarre experiences (BE), perceptual abnormalities (PA), persecutory ideas (PI) and grandiosity (GR). Intermittent, infrequent psychotic experiences were common, whereas frequent experiences were not. BE and PI were strongly associated with distress, depression and poor functioning. PA and GR were associated with these variables to a lesser degree. Different subtypes of PLEs were identified in this large s le, confirming the findings of our previous studies. These subtypes seem to have different psychopathological meaning and may therefore indicate different levels of risk of severe psychiatric disorders, which suggests it is misleading to define PLEs as a homogenous entity.
A disturbed sense of self in the psychosis prodrome: Linking phenomenology and neurobiology
Publisher: Elsevier BV
Date: 06-2009
DOI: 10.1016/J.NEUBIOREV.2009.01.002
Abstract: Interest in the early phase of psychotic disorders has risen dramatically in recent years. Neurobiological investigations have focused specifically on identifying brain changes associated with the onset of psychosis. The link between these neurobiological findings and the complex phenomenology of the early psychosis period is not well understood. In this article, we re-cast some of these observations, primarily from neuroimaging studies, in the context of phenomenological models of "the self" and disturbance thereof in psychotic illness. Specifically, we argue that disturbance of the basic or minimal self ("ipseity"), as articulated in phenomenological literature, may be associated with abnormalities in midline cortical structures as observed in neuroimaging studies of pre-onset and early psychotic patients. These findings are discussed with regards to current ideas on the neural basis of self-referential mental activity, including the notion of a putative "default-mode" of brain function, and its relation to distinguishing between self- and other-generated stimuli. Further empirical work examining the relationship between neurobiological and phenomenological variables may be of value in identifying risk markers for psychosis onset.
The pro-cognitive mechanisms of physical exercise in people with schizophrenia
Publisher: Wiley
Date: 20-04-2017
DOI: 10.1111/BPH.13772
Individualized Prediction of Transition to Psychosis in 1,676 Individuals at Clinical High Risk: Development and Validation of a Multivariable Prediction Model Based on Individual Patient Data Meta-An
Publisher: Frontiers Media SA
Date: 21-05-2019
Long-term employment among people at ultra-high risk for psychosis
Publisher: Elsevier BV
Date: 06-2017
DOI: 10.1016/J.SCHRES.2016.11.033
Abstract: Psychotic disorders are associated with high rates of sustained unemployment, however, little is known about the long-term employment outcome of people at ultra-high risk (UHR) of developing psychosis. We sought to investigate the long-term unemployment rate and baseline predictors of employment status at follow-up in a large UHR cohort. 268 UHR patients recruited from the Personal Assessment and Crisis Evaluation clinic in Melbourne, Australia were followed-up over 2-14years after initial presentation to the service. In iduals in no form of employment or education were classed as unemployed. Logistic regression analyses were used to examine predictors of employment outcome. A high rate of unemployment was present at follow-up in this UHR s le (23%). At baseline, those who were unemployed at follow-up had a longer duration of untreated illness, more severe negative symptoms, lower IQ, poorer social and occupational functioning and reported more childhood trauma than the employed group. At follow-up, unemployed in iduals exhibited significantly more severe symptoms on all measures and were more likely to have been diagnosed with a mood, anxiety, psychotic or substance use disorder. Childhood trauma and the duration of untreated illness at baseline were significant independent predictors of employment status at follow-up in the multivariate analyses. Nearly a quarter of this UHR s le was unemployed at long-term follow-up. The duration of untreated illness and the effects of childhood trauma are potentially modifiable risk factors for long-term employment outcome in this group. Vocational support may be beneficial for many UHR patients presenting to services.
Comment on Lee et al
Publisher: Elsevier BV
Date: 10-2014
Lessons learned from the psychosis high-risk state: Towards a general staging model of prodromal intervention
Publisher: Cambridge University Press (CUP)
Date: 18-02-2014
DOI: 10.1017/S0033291713000184
Abstract: The past two decades have seen exponential clinical and research interest in help-seeking in iduals presenting with potentially prodromal symptoms for psychosis. However, the epidemiological validity of this paradigm has been neglected, limiting future advancements in the field. We undertook a critical review of core epidemiological issues underlying the clinical high-risk (HR) state for psychosis and which model of prodromal intervention is best suited for mental health. The HR state for psychosis model needs refining, to bring together population-based findings of high levels of psychotic experiences (PEs) and clinical expression of risk. Traditionally, outcome has been attributed to ‘HR criteria’ alone rather than taking into account s ling strategies. Furthermore, the exclusive focus on variably defined ‘transition’ obscures true variation in the slow and non-linear progression across stages of psychopathology. Finally, the outcome from HR states is variable, indicating that the underlying paradigm of ‘schizophrenia light progressing to schizophrenia’ is inadequate. In the general population, mixed and non-specific expression of psychosis, depression, anxiety and subthreshold mania is common and mostly transitory. When combined with distress, it may be considered as the first, diagnostically neutral stage of potentially more severe psychopathology, which only later may acquire a degree of diagnostic specificity and possible relative resistance to treatment. Therefore, rather than creating silos of per-disorder ultra-HR syndromes, an early intervention focus on the broad syndrome of early mental distress, requiring phase-specific interventions, may be more profitable.
Adhesio interthalamica in individuals at high-risk for developing psychosis and patients with psychotic disorders
Publisher: Elsevier BV
Date: 10-2008
DOI: 10.1016/J.PNPBP.2008.07.007
Abstract: Abnormal neurodevelopment in midline structures such as the adhesio interthalamica (AI) has been reported in psychotic disorders, but it is unknown whether in iduals at risk for the disorder share the AI findings observed in patients with florid psychosis. Magnetic resonance imaging of 162 patients with first-episode psychosis (FEP), 89 patients with chronic schizophrenia, 135 in iduals at ultra high-risk (UHR) of psychosis (of whom 39 later developed psychosis), and 87 healthy controls were used to investigate the length and prevalence of the AI. The relation of the AI length to lateral ventricular enlargement was also explored. The patients with FEP and chronic schizophrenia as well as UHR in iduals had a shorter AI than the controls, but there was no difference in the AI findings between the UHR in iduals who did and did not subsequently develop psychosis. There was a negative correlation between the AI length and lateral ventricular volume in all the diagnostic groups. The absence of the AI was more common in the chronic schizophrenia patients when compared with all other groups. These results support the notion that the AI absence or shorter length could be a neurodevelopmental marker related to vulnerability to psychopathology, but also suggest that schizophrenia patients may manifest progressive brain changes related to ongoing atrophy of the AI after the onset.
WC4H PREDICTION OF PSYCHOSIS AND PROGRESSIVE CHANGE AFTER ILLNESS ONSET: STRUCTURAL NEUROIMAGING DATA FROM THE PACE CLINIC
Publisher: Elsevier BV
Date: 10-2006
Risk factors for psychosis in an ultra high-risk group: Psychopathology and clinical features
Publisher: Elsevier BV
Date: 04-2004
Markers of vulnerability to obsessive-compulsive disorder in an ultra-high risk sample of patients who developed psychosis
Publisher: Wiley
Date: 18-04-2012
DOI: 10.1111/J.1751-7893.2012.00357.X
Abstract: The study aims to identify markers of vulnerability to obsessive-compulsive disorder (OCD) in an ultra-high risk s le of patients who developed psychosis. Three hundred and eleven patients at ultra-high risk for psychosis were examined at baseline and after a mean of 7.4 years follow-up. Patients who developed psychosis with OCD (PSY + OCD n = 13) and psychosis without OCD (PSY - OCD n = 45) were compared in terms of socio-demographic and clinical features. PSY + OCD patients displayed greater severity of depression before and after conversion to PSY + OCD, and increased rates of depressive disorders before exhibiting PSY + OCD. However, they only displayed greater severity of anxiety and increased rates of non-OCD anxiety disorders after psychosis. Further, PSY + OCD patients were more likely to report a positive family history for anxiety disorders than PSY - OCD. Although depression and a family history of anxiety disorder may act as vulnerability markers for OCD in psychosis, the resulting anxiety may be a correlate or a consequence of PSY + OCD.
The prodromal phase of first-episode psychosis: Past and current conceptualizations
Publisher: Oxford University Press (OUP)
Date: 1996
Abstract: The initial prodrome in psychosis is potentially important for early intervention, identification of biological markers, and understanding the process of becoming psychotic. This article reviews the previous literature on prodrome, including descriptions of symptoms and signs, and patterns and durations of prodromes in both schizophrenic and affective psychoses. Early detailed descriptions, achieved through mainly anecdotal reports, are compared with current conceptualizations, such as the DSM-III-R checklist of mainly behavioral items, which seeks to enhance reliability of measurement but at the expense of adequately describing the full range of phenomena. Current confusion about the nature of prodromal features and concerns regarding the reliability of their measurement are highlighted. This article proposes an alternative model for conceptualizing prodromal changes (the hybrid/interactive model) and discusses the different ways to view this phase. The need for a more systematic evaluation of the prodromal phase in first-episode psychosis is emphasized.
Do affective or dissociative symptoms mediate the association between childhood sexual trauma and transition to psychosis in an ultra-high risk cohort?
Publisher: Elsevier BV
Date: 02-2016
DOI: 10.1016/J.PSYCHRES.2016.01.017
Abstract: We have previously reported an association between childhood sexual trauma and transition to psychosis in an Ultra High Risk (UHR) population. We aimed to investigate if this association was mediated by affective or dissociative symptoms. Data were from a large UHR for psychosis cohort study. None of the potential mediators (depression, anxiety, dissociation, mood swings and mania, assessed by the HAM-D, HAM-A and the CAARMS symptom scales) significantly mediated the total association between sexual abuse scores and transition. At the point of transition, the mechanistic pathway from sexual trauma to psychosis does not appear to operate through affective symptoms.
Heterogeneity of Psychosis Risk Within Individuals at Clinical High Risk
Publisher: American Medical Association (AMA)
Date: 02-2021
DOI: 10.1001/JAMAPSYCHIATRY.2015.2324
Abstract: In iduals can be classified as being at clinical high risk (CHR) for psychosis if they meet at least one of the ultra-high-risk (UHR) inclusion criteria (brief limited intermittent psychotic symptoms [BLIPS] and/or attenuated psychotic symptoms [APS] and/or genetic risk and deterioration syndrome [GRD]) and/or basic symptoms [BS]. The meta-analytical risk of psychosis of these different subgroups is still unknown. To compare the risk of psychosis in CHR in iduals who met at least one of the major inclusion criteria and in in iduals not at CHR for psychosis (CHR-). Electronic databases (Web of Science, MEDLINE, Scopus) were searched until June 18, 2015, along with investigation of citations of previous publications and a manual search of the reference lists of retrieved articles. We included original follow-up studies of CHR in iduals who reported the risk of psychosis classified according to the presence of any BLIPS, APS and GRD, APS alone, GRD alone, BS, and CHR-. Independent extraction by multiple observers and random-effects meta-analysis of proportions. Moderators were tested with meta-regression analyses (Bonferroni corrected). Heterogeneity was assessed with the I2 index. Sensitivity analyses tested robustness of results. Publication biases were assessed with funnel plots and the Egger test. The proportion of each subgroup with any psychotic disorder at 6, 12, 24, 36, and 48 or more months of follow-up. Thirty-three independent studies comprising up to 4227 in iduals were included. The meta-analytical proportion of in iduals meeting each UHR subgroup at intake was: 0.85 APS (95%CI, 0.79-0.90), 0.1 BLIPS (95%CI, 0.06-0.14), and 0.05 GRD (95%CI, 0.03-0.07). There were no significant differences in psychosis risk at any time point between the APS and GRD and the APS-alone subgroups. There was a higher risk of psychosis in the any BLIPS greater than APS greater than GRD-alone subgroups at 24, 36, and 48 or more months of follow-up. There was no evidence that the GRD subgroup has a higher risk of psychosis than the CHR- subgroup. There were too few BS or BS and UHR studies to allow robust conclusions. There is meta-analytical evidence that BLIPS represents separate risk subgroup compared with the APS. The GRD subgroup is infrequent and not associated with an increased risk of psychosis. Future studies are advised to stratify their findings across these different subgroups. The CHR guidelines should be updated to reflect these differences.
Adulthood revictimization: looking beyond childhood trauma
Publisher: Wiley
Date: 09-06-2016
DOI: 10.1111/ACPS.12602
Prognostic factors for progression to psychosis in high risk youth
Publisher: BMJ
Date: 08-2008
DOI: 10.1136/EBMH.11.3.72
Superior temporal gyrus volume in antipsychotic-naive people at risk of psychosis
Publisher: Royal College of Psychiatrists
Date: 03-2010
DOI: 10.1192/BJP.BP.109.069732
Abstract: Morphological abnormalities of the superior temporal gyrus have been consistently reported in schizophrenia, but the timing of their occurrence remains unclear. To determine whether in iduals exhibit superior temporal gyral changes before the onset of psychosis. We used magnetic resonance imaging to examine grey matter volumes of the superior temporal gyrus and its subregions (planum polare, Heschl's gyrus, planum temporale, and rostral and caudal regions) in 97 antipsychotic-naive in iduals at ultra-high risk of psychosis, of whom 31 subsequently developed psychosis and 66 did not, and 42 controls. Those at risk of psychosis had significantly smaller superior temporal gyri at baseline compared with controls bilaterally, without any prominent subregional effect however, there was no difference between those who did and did not subsequently develop psychosis. Our findings indicate that grey matter reductions of the superior temporal gyrus are present before psychosis onset, and are not due to medication, but these baseline changes are not predictive of transition to psychosis.
The relationship between personality traits and psychotic like experiences in a large non-clinical adolescent sample
Publisher: Elsevier BV
Date: 2015
The transition to psychosis: risk factors and brain changes
Publisher: Cambridge University Press (CUP)
Date: 09-2004
Psychotic-like experiences in a community sample of adolescents: Implications for the continuum model of psychosis and prediction of schizophrenia
Publisher: SAGE Publications
Date: 2009
DOI: 10.1080/00048670802607188
Abstract: Objective: Studies conducted in community s les suggest that psychotic-like experiences are common in the general population, leading to suggestions that they are either variations of normal personality or are different expressions of underlying vulnerability to psychotic disorder. Different types of psychotic symptoms may exist, some being normal variants and some having implications for mental health and functioning. The aim of the present study was to determine if different subtypes of psychotic-like experiences could be identified in a community s le of adolescents and to investigate if particular subtypes were more likely to be associated with psychosocial difficulties, that is, distress, depression and poor functioning, than other subtypes. Method: Eight hundred and seventy-five Year 10 students from 34 schools participated in a cross-sectional survey that measured psychotic-like experiences using the Community Assessment of Psychic Experiences depression using the Centre for Epidemiologic Studies Depression Scale and psychosocial functioning using the Revised Multidimensional Assessment of Functioning Scale. Factor analysis was conducted to identify any subtypes of psychotic experiences. Results: Four subtypes of psychotic-like experiences were identified: Bizarre Experiences, Perceptual Abnormalities, Persecutory Ideas, and Magical Thinking. Intermittent, infrequent psychotic experiences were common, but frequent experiences were not. Bizarre Experiences, Perceptual Abnormalities and Persecutory Ideas were strongly associated with distress, depression and poor functioning. Magical Thinking was only weakly associated with these variables. Overall these findings may suggest that infrequent psychotic-like experiences are unlikely to be a specific risk factor for onset of a psychotic disorder in community s les. Conclusions: Given that the different subtypes had varying associations with current difficulties it is suggested that not all subtypes confer the same risk for onset of psychotic disorder and poor outcome. Bizarre Experiences, Perceptual Abnormalities and Persecutory Ideas may represent expressions of underlying vulnerability to psychotic disorder, but Magical Thinking may be a normal personality variant.
The reality of at risk mental state services: a response to recent criticisms
Publisher: Cambridge University Press (CUP)
Date: 28-10-2021
DOI: 10.1017/S003329171900299X
Abstract: In the 1990s criteria were developed to detect in iduals at high and imminent risk of developing a psychotic disorder. These are known as the at risk mental state, ultra high risk or clinical high risk criteria. In iduals meeting these criteria are symptomatic and help-seeking. Services for such in iduals are now found worldwide. Recently Psychological Medicine published two articles that criticise these services and suggest that they should be dismantled or restructured. One paper also provides recommendations on how ARMS services should be operate. In this paper we draw on the existing literature in the field and present the perspective of some ARMS clinicians and researchers. Many of the critics' arguments are refuted. Most of the recommendations included in the Moritz et al . paper are already occurring. ARMS services provide management of current problems, treatment to reduce risk of onset of psychotic disorder and monitoring of mental state, including attenuated psychotic symptoms. These symptoms are associated with a range of poor outcomes. It is important to assess them and track their trajectory over time. A new approach to detection of ARMS in iduals can be considered that harnesses broad youth mental health services, such as headspace in Australia, Jigsaw in Ireland and ACCESS Open Minds in Canada. Attention should also be paid to the physical health of ARMS in iduals. Far from needing to be dismantled we feel that the ARMS approach has much to offer to improve the health of young people.
Impact of co-occurring substance use on 6 month outcomes for young people seeking mental health treatment
Publisher: SAGE Publications
Date: 11-2007
DOI: 10.1080/00048670701634986
Abstract: Objective: Co-occurring substance use and mental health disorders are highly prevalent among young people attending services, yet few studies have examined the effect of such comorbidity among those referred for treatment. The aim of the current study was to examine the impact of co-occurring substance use disorders (SUDs) on 6 month outcomes for young people seeking mental health treatment. Method: One hundred and six young people (aged 15–24 years) with a non-psychotic DSM-IV Axis I disorder were assessed following referral to a specialist youth public mental health service. Participants were given a structured interview, as well as questionnaires assessing drug use, psychopathology, psychosocial functioning and self-esteem at baseline and 6 month follow up. Results: At baseline, 23 participants met criteria for a co-occurring SUD and 83 had a non-psychotic Axis I disorder. Both the non-SUD and the co-occurring SUD groups had high levels of psychopathology, serious impairments in functioning and moderate levels of suicidal ideation, although those with co-occurring SUD had significantly poorer levels of functioning. At 6 month follow up the co-occurring SUD group continued to experience substantial problems with symptoms and functioning whereas the non-SUD group had significant improvement in both of these domains. Conclusions: The present findings are consistent with studies examining the impact of co-occurring substance use and mental health issues across different treatment settings, and reinforce recommendations that young people with co-occurring disorders require more intensive and integrated interventions. The present findings also highlight the need for routine assessment and management of substance use issues within youth mental health settings.
A longitudinal study of obsessive-compulsive disorder in individuals at ultra-high risk for psychosis
Publisher: Elsevier BV
Date: 09-2011
DOI: 10.1016/J.JPSYCHIRES.2011.03.005
Abstract: We evaluated whether (1) a diagnosis of obsessive-compulsive disorder (OCD) at baseline, or (2) the persistence, remission or emergence of de novo OCD at follow-up, were associated with the development of different psychotic disorders in a cohort of in iduals at ultra-high risk (UHR) for psychosis. Patients were assessed for OCD at baseline and after a mean of 7.4 years follow-up and classified into: (i) Non-OCD group - patients without OCD both at baseline and follow-up (n = 269 86.2%), (ii) Incident OCD group - patients without OCD at baseline but with OCD at follow-up (n = 17 5.4%), (iii) Remitting OCD group - patients with OCD at baseline but without OCD at follow-up (n = 20 6.4%), (iv) Persistent OCD group - patients with OCD both at baseline and at follow-up (n = 6 1.9%). Rates of different DSM-IV psychotic disorders at follow-up were compared across these groups. Patients who displayed remitting OCD were not related to the development of any DSM-IV psychotic disorder. A diagnosis of incident OCD was associated with greater rates of psychotic disorders at follow-up, particularly mood disorders with psychotic features and psychotic disorders not otherwise specified (PDNOS), and greater baseline severity of general psychopathology, alogia, and avolition-apathy. Two of the six patients (40%) with persistent OCD developed schizophrenia, while only 12.5%, 5.0%, and 9.7% of incident, remitting, and non-OCD groups, respectively, exhibited the same condition at follow-up. Rates of antipsychotic use in the previous two years were not significantly different between the groups. Our findings suggest that, in a cohort of in iduals at UHR for psychosis, remission of OCD does not increase the risk of psychosis, while de novo OCD was associated with development of mood disorders with psychotic features and PDNOS.
A Review of International Biobanks and Networks: Success Factors and Key Benchmarks—A 10-Year Retrospective Review
Publisher: Mary Ann Liebert Inc
Date: 12-2019
Association between psychotic experiences and depression in a clinical sample over 6 months
Publisher: Elsevier BV
Date: 03-2007
DOI: 10.1016/J.SCHRES.2006.11.026
Abstract: Psychotic-like experiences (PLEs) are used to identify in iduals considered to be at Ultra High Risk (UHR) of, or prodromal for, psychotic disorder. They are also common in the general population and in clinical s les of non-psychotic in iduals. Depression has been found to be an important factor in mediating outcome in those with PLEs in both community and UHR populations. It is associated with increased risk of transition to psychotic disorder in the UHR group, and with need for care in relation to PLEs in community s les. In this study we aimed to examine the 6-month outcome of PLEs in a s le of help-seeking young people aged 15 to 24 years in relation to their level of depression. Subjects (n=140) were assessed at baseline and 6 months for PLEs and depression. PLEs were measured by the Community Assessment of Psychic Experiences (CAPE). Depression was assessed as a continuous measure using the Mood and Anxiety Symptom Questionnaire (MASQ) and categorically according to DSM-IV diagnosis of mood disorder. PLEs reduced in conjunction with an improvement in depression level and with remission of diagnosis of mood disorder. It is important to assess depression in those with PLEs and consider the need for treatment of the comorbid depressive syndrome. This may reduce the risk of worsening of PLEs and transition to psychotic disorder.
Hippocampal abnormalities in schizophrenia: Findings from neurotransmitter and structural imaging studies
Publisher: Elsevier BV
Date: 1998
Using clinical information to make individualized prognostic predictions in people at ultra high risk for psychosis
Publisher: Elsevier BV
Date: 06-2017
Neuroimaging and emerging psychotic disorders: The Melbourne ultra-high risk studies
Publisher: Informa UK Limited
Date: 2007
Cognitive Functioning in Prodromal Psychosis
Publisher: American Medical Association (AMA)
Date: 06-2012
DOI: 10.1001/ARCHGENPSYCHIATRY.2011.1592
Abstract: A substantial proportion of people at clinical high risk (HR) of psychosis will develop a psychotic disorder over time. Cognitive deficits may predate the onset of psychosis and may be useful as markers of increased vulnerability to illness. To quantitatively examine the cognitive functioning in subjects at HR in the literature to date. Electronic databases were searched until January 2011. All studies reporting cognitive performance in HR subjects were retrieved. Nineteen studies met the inclusion criteria, comprising a total of 1188 HR subjects and 1029 controls. Neurocognitive functioning and social cognition as well as demographic, clinical, and methodological variables were extracted from each publication or obtained directly from its authors. Subjects at HR were impaired relative to controls on tests of general intelligence, executive function, verbal and visual memory, verbal fluency, attention and working memory, and social cognition. Processing speed domain was also affected, although the difference was not statistically significant. Later transition to psychosis was associated with even more marked deficits in the verbal fluency and memory domains. The studies included reported relatively homogeneous findings. There was no publication bias and a sensitivity analysis confirmed the robustness of the core results. The HR state for psychosis is associated with significant and widespread impairments in neurocognitive functioning and social cognition. Subsequent transition to psychosis is particularly associated with deficits in verbal fluency and memory functioning.
The EPOS prediction model improves ability to predict transition to first episode psychosis in individuals at high risk
Publisher: BMJ
Date: 03-08-2010
DOI: 10.1136/EBMH.13.3.77
Obstetric complications and transition to psychosis in an 'ultra' high risk sample
Publisher: SAGE Publications
Date: 06-2005
Hippocampal and amygdala volumes according to psychosis stage and diagnosis: A magnetic resonance imaging study of chronic schizophrenia, first-episode psychosis, and ultra-high-risk individuals
Publisher: American Medical Association (AMA)
Date: 02-2006
DOI: 10.1001/ARCHPSYC.63.2.139
Abstract: Magnetic resonance imaging studies have identified hippoc al volume reductions in schizophrenia and amygdala volume enlargements in bipolar disorder, suggesting different medial temporal lobe abnormalities in these conditions. These studies have been limited by small s les and the absence of patients early in the course of illness. To investigate hippoc al and amygdala volumes in a large s le of patients with chronic schizophrenia, patients with first-episode psychosis, and patients at ultra-high risk for psychosis compared with control subjects. Cross-sectional comparison between patient groups and controls. In iduals with chronic schizophrenia were recruited from a mental health rehabilitation service, and in iduals with first-episode psychosis and ultra-high risk were recruited from the ORYGEN Youth Health Service. Control subjects were recruited from the community. The study population of 473 in iduals included 89 with chronic schizophrenia, 162 with first-episode psychosis, 135 at ultra-high risk for psychosis (of whom 39 subsequently developed a psychotic illness), and 87 controls. Hippoc al, amygdala, whole-brain, and intracranial volumes were estimated on high-resolution magnetic resonance images and compared across groups, including first-episode subgroups. We used 1- and 2-way analysis of variance designs to compare hippoc al and amygdala volumes across groups, correcting for intracranial volume and covarying for age and sex. We investigated the effects of medication and illness duration on structural volumes. Patients with chronic schizophrenia displayed bilateral hippoc al volume reduction. Patients with first-episode schizophrenia but not schizophreniform psychosis displayed left hippoc al volume reduction. The remaining first-episode subgroups had normal hippoc al volumes compared with controls. Amygdala volume enlargement was identified only in first-episode patients with nonschizophrenic psychoses. Patients at ultra-high risk for psychosis had normal baseline hippoc al and amygdala volumes whether or not they subsequently developed a psychotic illness. Structural volumes did not differ between patients taking atypical vs typical antipsychotic medications, and they remained unchanged when patients treated with lithium were excluded from the analysis. Medial temporal structural changes are not seen until after the onset of a psychotic illness, and the pattern of structural change differs according to the type of psychosis. These findings have important implications for future neurobiological studies of psychotic disorders and emphasize the importance of longitudinal studies examining patients before and after the onset of a psychotic illness.
How age and gender predict illness course in a first-episode nonaffective psychosis cohort
Publisher: Physicians Postgraduate Press, Inc
Date: 16-02-2016
DOI: 10.4088/JCP.14M09369
Dynamic Association Between Interpersonal Functioning and Positive Symptom Dimensions of Psychosis Over Time: A Longitudinal Study of Healthy Adolescents
Publisher: Oxford University Press (OUP)
Date: 19-09-2011
Altered depth of the olfactory sulcus in ultra high-risk individuals and patients with psychotic disorders
Publisher: Elsevier BV
Date: 03-2014
DOI: 10.1016/J.SCHRES.2014.01.041
Abstract: A shallow olfactory sulcus has been reported in schizophrenia, possibly reflecting abnormal forebrain development during early gestation. However, it remains unclear whether this anomaly exists prior to the onset of psychosis and/or differs according to illness stage. In the current study, magnetic resonance imaging was used to investigate the length and depth of the olfactory sulcus in 135 ultra high-risk (UHR) in iduals [of whom 52 later developed psychosis (UHR-P) and 83 did not (UHR-NP)], 162 patients with first-episode psychosis (FEP), 89 patients with chronic schizophrenia, and 87 healthy controls. While there was no group difference in the length of the sulcus, UHR-P subjects had significantly shallower olfactory sulcus at baseline as compared with UHR-NP and control subjects. The depth of this sulcus became increasingly more superficial as one moved from UHR-P subjects to FEP patients to chronic schizophrenia patients. Finally, the depth of the olfactory sulcus in the UHR-P subjects was negatively correlated with the severity of negative symptoms. These findings suggest that the altered depth of the olfactory sulcus, which exists before psychosis onset, could be predictive of transition to psychosis, but also suggest ongoing changes of the sulcus morphology during the course of the illness.
Genomic cloud computing: legal and ethical points to consider
Publisher: Springer Science and Business Media LLC
Date: 24-09-2014
S.22.01 Brain changes during the development of psychosis
Publisher: Elsevier BV
Date: 10-2007
The prevention of schizophrenia
Publisher: Informa UK Limited
Date: 2007
DOI: 10.1080/09540260701797803
Abstract: Preventive strategies can be ided into universal, selective and indicated prevention and early intervention. Universal interventions are directed to the general population. Selective approaches are targeted at people who have risk factors for an illness, but who do not show any current signs. Indicated approaches target high risk in iduals with minimal signs or symptoms foreshadowing mental disorder, but who do not meet diagnostic levels at the current time. Early intervention involves treating those with already diagnosable disorder in a timely and optimal manner aiming to decrease the severity of the illness, and reduce secondary morbidity. Although universal and selective interventions are not yet viable strategies, indicated prevention and early intervention are now realistic possibilities in schizophrenia. Development of methods to identify those at risk of psychosis continues to evolve. Promising results in the prevention and delay of transition to psychotic disorder from high risk state have been found. Early intervention in schizophrenia, including promotion of early help-seeking, has been shown to reduce the duration of untreated psychosis, which is known to be associated with poor outcome in schizophrenia. Early intervention programmes which optimise the care of the first episode have been shown to produce better outcomes than routine management.
Effects of NRG1 and DAOA genetic variation on transition to psychosis in individuals at ultra-high risk for psychosis
Publisher: Springer Science and Business Media LLC
Date: 30-04-2013
DOI: 10.1038/TP.2013.23
Long-term Follow-up of a Group at Ultra High Risk (“Prodromal”) for Psychosis
Publisher: American Medical Association (AMA)
Date: 08-2013
DOI: 10.1001/JAMAPSYCHIATRY.2013.1270
Abstract: The ultra high-risk (UHR) criteria were introduced to prospectively identify patients at high risk of psychotic disorder. Although the short-term outcome of UHR patients has been well researched, the long-term outcome is not known. To assess the rate and baseline predictors of transition to psychotic disorder in UHR patients up to 15 years after study entry. Follow-up study of a cohort of UHR patients recruited to participate in research studies between 1993 and 2006. The Personal Assessment and Crisis Evaluation (PACE) clinic, a specialized service for UHR patients in Melbourne, Australia. Four hundred sixteen UHR patients previously seen at the PACE clinic. Transition to psychotic disorder, as measured using the Comprehensive Assessment of At-Risk Mental States, Brief Psychiatric Rating Scale/Comprehensive Assessment of Symptoms and History, or state public mental health records. During the time to follow-up (2.4-14.9 years after presentation), 114 of the 416 participants were known to have developed a psychotic disorder. The highest risk for transition was within the first 2 years of entry into the service, but in iduals continued to be at risk up to 10 years after initial referral. The overall rate of transition was estimated to be 34.9% over a 10-year period (95% CI, 28.7%-40.6%). Factors associated with transition included year of entry into the clinic, duration of symptoms before clinic entry, baseline functioning, negative symptoms, and disorders of thought content. The UHR patients are at long-term risk for psychotic disorder, with the highest risk in the first 2 years. Services should aim to follow up patients for at least this period, with the possibility to return for care after this time. In iduals with a long duration of symptoms and poor functioning at the time of referral may need closer monitoring. Interventions to improve functioning and detect help-seeking UHR patients earlier also may be indicated.
Prospective outcome of early intervention for individuals at ultra‐high‐risk for psychosis
Publisher: Wiley
Date: 23-10-2008
DOI: 10.1111/J.1751-7893.2008.00089.X
Abstract: Based on previous reports of second-generation antipsychotic agents having a beneficial effect on prodromal symptoms, we investigated the effectiveness and tolerability of atypical antipsychotic therapies in in iduals at high risk for developing psychosis. We examined prodromal symptoms and functioning in in iduals at ultra-high-risk for psychosis using an uncontrolled prospective design with pre- and post-treatment measures. Of the 27 subjects taking antipsychotics during the study period, 15 took part in at least one follow-up assessment. Overall Comprehensive Assessment of At-Risk Mental States scores significantly improved at the last evaluation point, with a medium-size effect of Cohen's d = 0.54 (95% confidence interval, -0.02 to 1.08) (mean follow-up period = 8.8 SD = 8.3 months). Depression and anxiety symptoms were markedly reduced, and global and social functioning also significantly improved. Of the 27 subjects, two (7.4%) converted to psychosis and 16 (59.3%) experienced at least one treatment-emergent adverse event, but no subjects exhibited serious adverse events. The results of this study support treating high-risk in iduals with antipsychotics to reduce prodromal symptoms with adequate safety.
Keeping an open mind: Investigating options for treatment of the pre-psychotic phase
Publisher: Informa UK Limited
Date: 2003
Gym rats: exercise reverses cognitive impairment in the phencyclidine rat model of schizophrenia
Publisher: Elsevier BV
Date: 03-2017
Prepsychotic phase of schizophrenia and related disorders: Recent progress and future opportunities
Publisher: Royal College of Psychiatrists
Date: 08-2005
Abstract: Clinical and research focus has recently shifted from established psychotic disorders to first-episode psychosis and the prepsychotic phase of illness. To describe the principles, progress and dilemmas associated with the prospective detection, engagement and treatment of young people at risk of developing a psychotic disorder. Strategies to identify young people at heightened risk of a psychotic disorder are described. Preventive interventions and results of their evaluation are provided. Well-validated criteria for identifying young people at heightened risk of psychosis have been developed, evidence of the efficacy of various psychological and pharmacological interventions in preventing progression has accumulated and progress towards the identification of clinical and neurobiological predictors of transition to acute psychosis has been made. The detection, monitoring and treatment of young people in the prepsychotic phase is a growth area in psychiatry. The ethical considerations about treatment options, treatment of minors and provision of information about risk status must be treated with sensitivity if the potential benefit to many young people and their families is to be realised.
The PACE Clinic: Identification and Management of Young People at “Ultra” High Risk of Psychosis
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2002
DOI: 10.1097/00131746-200209000-00002
Abstract: Over the past decade, both clinical and research interest in the early stages of psychotic disorders has grown. This has been associated with research suggesting that early intervention in these disorders may limit their impact on the life of the affected in idual and his or her family. It has also been recognized that the biological and psychological changes underpinning the development of psychotic disorders may already be active in the prepsychotic or prodromal phase. It has been suggested that efforts to prevent psychotic disorders should be focused on this phase of emerging illness. In this article, the authors review work conducted at the PACE Clinic in Melbourne, Australia since 1994. This clinical research program was established to develop strategies for identifying young people at high risk for developing a psychotic disorder within a short period. The program has also investigated biological and psychological processes thought to underlie the development of psychosis and evaluated potential preventive interventions.
The structure of the ultra high risk mental state for psychosis. A latent class cluster analysis study
Publisher: Cambridge University Press (CUP)
Date: 03-2011
DOI: 10.1016/S0924-9338(11)73790-7
Abstract: In iduals at Ultra High Risk (UHR) for psychosis typically present with attenuated psychotic symptoms. However it is difficult to predict which in iduals will later develop frank psychosis when their mental state is rated in terms of in idual symptoms. The objective of the study was to examine the phenomenological structure of the UHR mental state and identify symptom profiles that predict later transition to psychosis. Psychopathological data from a large s le of UHR subjects were analysed using latent class cluster analysis. A total of 318 in iduals with a UHR for psychosis. Data were collected from two specialised community mental health services for people at UHR for psychosis: OASIS in London and PACE, in Melbourne. Latent class cluster analysis produced 4 classes: Class 1 - Mild was characterized by lower scores on all the CAARMS items. Subjects in Class 2 - Moderate scored moderately on all CAARMS items and was more likely to be in employment. Those in Class 3 - Moderate-Severe scored moderately-severe on negative symptoms, social isolation and impaired role functioning. Class 4 - Severe was the smallest group and was associated with the most impairment: subjects in this class scored highest on all items of the CAARMS, had the lowest GAF score and were more likely to be unemployed. This group was also characterized by the highest transition rate (41%). Different constellations of symptomatology are associates with varying levels of risk to of transition to psychosis.
Enhancing social functioning in young people at Ultra High Risk (UHR) for psychosis: A pilot study of a novel strengths and mindfulness-based online social therapy
Publisher: Elsevier BV
Date: 12-2018
DOI: 10.1016/J.SCHRES.2018.07.022
Abstract: Psychological and pharmacological treatments have been shown to reduce rates of transition to psychosis in Ultra High Risk (UHR) young people. However, social functioning deficits have been unresponsive to current treatments. The study aims were to: i) describe the theoretical basis and therapeutic targets of a novel intervention targeting social functioning in UHR young people and ii) examine its acceptability, safety and preliminary effect on social functioning. An international, multidisciplinary team developed a new intervention (MOMENTUM) to improve social functioning in UHR young people. MOMENTUM blends two novel approaches to social recovery: strengths and mindfulness-based intervention embedded within a social media environment, and application of the self-determination theory of motivation. The acceptability and safety of MOMENTUM were tested through a 2-month pilot study with 14 UHR participants. System usage was high, with over 70% of users being actively engaged over the trial. All participants reported a positive experience using MOMENTUM, considered it safe and would recommend it to others. 93% reported it to be helpful. There were large, reliable improvements in social functioning (d = 1.83, p < 0.001) and subjective wellbeing (d = 0.75, p = 0.03) at follow-up. There were significant increases in the mechanisms targeted by the intervention including strengths usage (d = 0.70, p = 0.03), mindfulness skills (d = 0.66, p = 0.04) and components of social support. Social functioning improvement was significantly correlated with indicators of system usage. MOMENTUM is engaging and safe. MOMENTUM appeared to engage the hypothesized mechanisms and showed promise as a new avenue to improve social functioning in UHR young people.
The youth model in mental health services
Publisher: SAGE Publications
Date: 2008
Prescribing in schizophrenia and psychosis: Increasing polypharmacy over time
Publisher: Wiley
Date: 03-2017
DOI: 10.1002/HUP.2579
Abstract: Diabetes, obesity, and metabolic syndrome are highly prevalent in patients with severe mental illness. Psychotropic polypharmacy is becoming increasingly prevalent within the UK. We determined the change in the number of psychotropic medications prescribed over time and trends in weight and fasting blood glucose. One hundred ninety-five in iduals with schizophrenia and psychosis on the Severe Mental Illness Register in Cheshire, UK, were followed up between 2004 and 2012. In iduals were identified through a semianonymised search of general practitioner registers. The total number of different medications prescribed increased from 140 in 2004 to 226 in 2012 with the mean number of medication groups per patient increasing from 0.71 to 1.15 (p < .001). The number of in iduals on no medication reduced from 58.0% to 33.3%, OR 0.36 95% CI [0.24, 0.54], and those prescribed one medication increased from 20.5% to 31.8%, OR 1.93 95% CI [1.22-3.06]. Baseline body mass index was 28.9, increasing to 30.8 at 8-year follow-up, F(6.5), p = .003, with a significant corresponding increase in fasting blood glucose. In conclusion, we determined an increase in psychotropic polypharmacy over the follow-up period. Body mass index or fasting blood glucose increased over time. Clozapine and depot antipsychotic prescriptions were often not recorded in the general practitioner records.
PROGRESSIVE GRAY MATTER REDUCTION OF THE SUPERIOR TEMPORAL GYRUS DURING TRANSITION TO PSYCHOSIS
Publisher: American Medical Association (AMA)
Date: 04-2009
DOI: 10.1001/ARCHGENPSYCHIATRY.2009.12
Abstract: Longitudinal magnetic resonance imaging studies have shown progressive gray matter reduction in the superior temporal gyrus during the earliest phases of schizophrenia. It is unknown whether these progressive processes predate the onset of psychosis. To examine gray matter reduction of the superior temporal gyrus over time in in iduals at risk for psychosis and in patients with first-episode psychosis. Cross-sectional and longitudinal comparisons. Personal Assessment and Crisis Evaluation Clinic and Early Psychosis Preventions and Intervention Centre. Thirty-five ultrahigh-risk in iduals (of whom 12 later developed psychosis [UHRP] and 23 did not [UHRNP]), 23 patients with first-episode psychosis (FEP), and 22 control subjects recruited from the community. Volumes of superior temporal subregions (planum polare, Heschl gyrus, planum temporale, and rostral and caudal regions) were measured at baseline and follow-up (mean, 1.8 years) and were compared across groups. In cross-sectional comparisons, only the FEP group had significantly smaller planum temporale and caudal superior temporal gyrus than other groups at baseline, whereas male UHRP subjects also had a smaller planum temporale than controls at follow-up. In longitudinal comparison, UHRP and FEP patients showed significant gray matter reduction (approximately 2%-6% per year) in the planum polare, planum temporale, and caudal region compared with controls and/or UHRNP subjects. The FEP patients also exhibited progressive gray matter loss in the left Heschl gyrus (3.0% per year) and rostral region (3.8% per year), which were correlated with the severity of delusions at follow-up. A progressive process in the superior temporal gyrus precedes the first expression of florid psychosis. These findings have important implications for underlying neurobiologic features of emerging psychotic disorders and emphasize the importance of early intervention during or before the first episode of psychosis.
Ventricular volumes across stages of schizophrenia and other psychoses
Publisher: SAGE Publications
Date: 07-2017
Abstract: Ventricular enlargement is common in established schizophrenia however, data from ultra high-risk for psychosis and first-episode psychosis studies are inconclusive. This study aims to investigate ventricular volumes at different stages of psychosis. Ventricular volumes were measured using a semi-automated and highly reliable method, for 89 established schizophrenia, 162 first-episode psychosis, 135 ultra high-risk for psychosis and 87 healthy controls using 1.5T magnetic resonance images. Clinical outcome diagnoses for ultra high-risk for psychosis were evaluated at long-term follow-up (mean: 7.5 years). Compared to controls, we identified significant ventricular enlargement of 36.2% in established schizophrenia ( p < 0.001). Ventricular enlargement was not significant in first-episode psychosis (6%) or ultra high-risk for psychosis (-3%). Examination across stages of schizophrenia-spectrum diagnoses subgroups revealed a significant linear trend ( p = 0.006 established schizophrenia = 36.2%, first-episode psychosis schizophrenia = 18.5%, first-episode psychosis schizophreniform = -4.2% and ultra high-risk for psychosis-schizophrenia converters = -18.5%). Ventricular enlargement is apparent in patients with established schizophrenia but is not a feature at the earliest stages of illness (ultra high-risk for psychosis and first-episode psychosis). Further research is needed to fully characterize the nature and timing of ventricular volume changes early in the course of illness and how these changes impact outcomes.
Preventing a first episode of psychosis: Meta-analysis of randomized controlled prevention trials of 12month and longer-term follow-ups
Publisher: Elsevier BV
Date: 09-2013
DOI: 10.1016/J.SCHRES.2013.07.004
Abstract: Over the last decade many studies were conducted to assess the feasibility of early detection of people at risk of developing psychosis and intervention to prevent or delay a first psychotic episode. Most of these studies were small and underpowered. A meta-analysis can demonstrate the effectiveness of the efforts to prevent or postpone a first episode of psychosis. A search conducted according the PRISMA guideline identified 10 studies reporting 12-month follow-up data on transition to psychosis, and 5 studies with follow-ups varying from 24 to 48 months. Both random and fixed effects meta-analyses were conducted. The quality of the studies varied from poor to excellent. Overall the risk reduction at 12 months was 54% (RR=0.463 95% CI=0.33-0.64) with a Number Needed to Treat (NNT) of 9 (95% CI=6-15). Although the interventions differed, there was only mild heterogeneity and publication bias was small. All sub-analyses demonstrated effectiveness. Also 24 to 48-month follow-ups were associated with a risk reduction of 37% (RR=.635 95% CI=0.44-0.92) and a NNT of 12 (95% CI=7-59). Sensitivity analysis excluding the methodologically weakest study showed that the findings were robust. Early detection and intervention in people at ultra-high risk of developing psychosis can be successful to prevent or delay a first psychosis. Antipsychotic medication showed efficacy, but more trials are needed. Omega-3 fatty acid needs replication. Integrated psychological interventions need replication with more methodologically sound studies. The findings regarding CBT appear robust, but the 95% confidence interval is still wide.
The ultra high risk approach to define psychosis risk
Publisher: Bentham Science Publishers Ltd.
Date: 02-2012
DOI: 10.2174/138161212799316299
Abstract: Although prodromal symptoms of psychosis have long been recognized, the clinical management of psychotic disorders conventionally begins at the first episode of frank psychosis, and, until recently, the period immediately preceding the first episode received relatively little attention. Over the last fifteen years, there has been increasing academic and clinical interest in people presenting with potentially prodromal symptoms. This clinical syndrome has been termed an "At Risk Mental State", and operationalised criteria, the "Ultra High Risk (UHR)", or "Clinical High Risk" criteria, have been developed to identify the syndrome. We will review here the mainstreams of the UHR paradigms focusing on the conceptual basis, potentials and limitations in current psychiatric research.
Stress and HPA-axis functioning in young people at ultra high risk for psychosis
Publisher: Elsevier BV
Date: 10-2007
DOI: 10.1016/J.JPSYCHIRES.2006.05.010
Abstract: It is thought that hypothalamic-pituitary-adrenal (HPA) axis functioning mediates between the experience of stress and development of psychotic symptoms. This study aimed to evaluate this model in a cohort of young people at ultra high risk (UHR) of psychosis. Information about the experience of psychological symptoms and recent stressful experiences was obtained from 23 young people who met UHR criteria. Plasma s les were taken to assess cortisol and glucocorticoid receptor numbers, and an MRI scan was also performed. Plasma cortisol levels were significantly and positively correlated with the experience of 'hassles' but not with the experience of stressful life events. Significant positive associations were also found between plasma cortisol levels and level of depression and anxiety. No significant relationships were found between plasma cortisol level and global psychopathology, psychotic symptomatology, functioning or pituitary and hippoc al volumes. These results suggest that the number of hassles experienced by young people at UHR of psychosis could be an important factor in raising their cortisol levels, which might, in turn, affect the severity of depressive and anxiety symptoms. No other relationships were found between plasma cortisol levels and the experience of psychotic symptoms, functioning or hippoc al and pituitary volumes. These results indicate possible impairment in HPA-axis functioning in the early stages of psychotic illness, but further investigation of the relationships between these parameters is required.
0264 ASSESSING THOSE AT HIGH RISK OF PSYCHOTIC DISORDER USING THE COMPREHENSIVE ASSESSMENT OF AT RISK MENTAL STATES (CAARMS)
Publisher: Elsevier BV
Date: 10-2006
Phenylthiocarbamide (PTC) perception in ultra-high risk for psychosis participants who develop schizophrenia: Testing the evidence for an endophenotypic marker
Publisher: Elsevier BV
Date: 08-2012
Further examination of the reducing transition rate in ultra high risk for psychosis samples: The possible role of earlier intervention
Publisher: Elsevier BV
Date: 07-2016
DOI: 10.1016/J.SCHRES.2016.04.040
Abstract: The rate of transition to psychotic disorder in ultra high risk (UHR) patients has declined in recent cohorts. The reasons for this are unclear, but may include a lead-time bias, earlier intervention, a change in clinical characteristics of cohorts, and treatment changes. In this paper we examined the two possibilities related to reduction in duration of symptoms prior to clinic entry, i.e., lead-time bias and earlier intervention. The s le consisted of all UHR research participants seen at the PACE clinic, Melbourne between 1993 and 2006 (N=416), followed for a mean of 7.5years (the 'PACE 400' cohort). Duration of symptoms was analysed by four baseline year time periods. Analysis of transition rate by duration of symptoms was restricted to more homogenous sub-s les (pre-1998 and pre-2001) in order to minimize confounding effects of change in patient characteristics or treatments. These cohorts were ided into those with a short and long duration of symptoms using a cut-point approach. Duration of symptoms prior to entry did not reduce significantly between 1993 and 2006 (p=0.10). The group with a short duration of symptoms showed lower transition rates and did not catch up in transition rate compared to the long duration of symptoms group. These data suggest that, while earlier intervention or lead-time bias do not fully account for the declining transition rate in UHR cohorts, it appears that earlier intervention may have exerted a stronger influence on this decline than length of follow-up period (lead-time bias).
Related Organisations
Greater Manchester West Mental Health NHS Foundation Trust
Location: United Kingdom of Great Britain and Northern Ireland
University Of Manchester
Location: United Kingdom of Great Britain and Northern Ireland
Related Funding Activities
No related grants have been discovered for Alison Yung.