Findings of abnormal white matter development provide direct empirical evidence to support prominent neurodevelopmental theories. The predictive relationships between NSS and longitudinal cerebellar-thalamic tract integrity and negative symptom course provide insight into the role of cognitive dysmetria in the high-risk period and inform on a unique biomarker tied to core features underlying psychosis.

Background Sleep dysfunction is a pervasive, distressing characteristic of psychosis, yet little is known regarding sleep quality prior to illness onset. At present, it is unclear whether sleep dysfunction precedes the emergence of psychotic symptoms, signifying a core feature of the disorder, or if it represents a consequence of prolonged contact with aspects of schizophrenia and its treatment (e.g., medication use or neurotoxicity) or co-morbid symptoms (e.g., depressive and manic symptomatology). The current study examined sleep dysfunction in adolescents at ultra high-risk (UHR) for psychosis, relationships between sleep disturbances and psychosis symptoms, volume of an integral sleep-structure (thalamus), and associations between thalamic abnormalities and sleep impairment in UHR youth. Method Thirty-three UHR youth and 33 healthy controls (HC) participated in a self-assessment of sleep functioning (Pittsburgh Sleep Quality Index; PSQI), self and parent-report clinical interviews, and structural magnetic resonance imaging (MRI). Results UHR adolescents displayed increased latency to sleep onset and greater sleep disturbances/disrupted continuity compared to HC youth, over and above concurrent mood symptoms. Among UHR youth, increased sleep dysfunction was associated with greater negative symptom severity but not positive symptoms. Compared to HC adolescents, UHR participants displayed decreased bilateral thalamus volume, which was associated with increased sleep dysfunction. Conclusions Sleep dysfunction occurs during the pre-psychotic period, and may play a role in the etiology and pathophysiology of psychosis. In addition, the relationship of disrupted sleep to psychosis symptoms in UHR youth indicates that prevention and intervention strategies may be improved by targeting sleep stabilization in the pre-psychotic period.

Youth and young adults at clinical high risk (CHR) for psychosis experience a broad range of difficulties, including attenuated psychotic symptoms, comorbid concerns, functional impairments, and family and interpersonal stress. Given emerging evidence that early interventions may improve functioning and reduce symptomatology while also lowering risk of transition to full-threshold psychosis, several randomized controlled trials have systematically evaluated the efficacy of CHR treatment approaches. This article describes and summarizes psychosocial intervention approaches that have demonstrated efficacy in treating people at CHR, with a focus on distilling individual components of these treatments. On the basis of the existing literature, we propose an empirically based, flexible, and comprehensive modularized approach to early intervention that meets the varying needs of individuals experiencing CHR-related distress and dysfunction, many of whom may be on a trajectory toward psychosis.

A growing body of evidence suggests that moderate to vigorous activity levels can affect quality of life, cognition, and brain structure in patients diagnosed with schizophrenia. However, physical activity has not been systematically studied during the period immediately preceding the onset of psychosis. Given reports of exercise-based neurogenesis in schizophrenia, understanding naturalistic physical activity levels in the prodrome may provide valuable information for early intervention efforts. The present study examined 29 ultra high-risk (UHR) and 27 matched controls to determine relationships between physical activity level, brain structure (hippocampus and parahippocampal gyrus), and symptoms. Participants were assessed with actigraphy for a 5-day period, magnetic resonance imaging (MRI), and structured clinical interviews. UHR participants showed a greater percentage of time in sedentary behavior while healthy controls spent more time engaged in light to vigorous activity. There was a strong trend to suggest the UHR group showed less total physical activity. The UHR group exhibited smaller medial temporal volumes when compared to healthy controls. Total level of physical activity in the UHR group was moderately correlated with smaller parahippocampal gyri bilaterally (right: r=.44, left: r=.55) and with occupational functioning (r=−.36; of negative symptom domain), but not positive symptomatology. Results suggest that inactivity is associated with medial temporal lobe health. Future studies are needed to determine if symptoms are driving inactivity, which in turn may be affecting the health of the parahippocampal structure and progression of illness. Although causality cannot be determined from the present design, these findings hold important implications for etiological conceptions and suggest promise for an experimental trial.

Research suggests that individuals may benefit from participation in a partial hospital program (PHP) following discharge from inpatient psychiatric hospitalization. Indeed, PHPs are designed to facilitate further stabilization and skill-building before discharge to the community. As a result, our hospital-located in a large metropolitan area in the Northeastern United States-has long maintained a commitment to providing this critical level of care. However, during the COVID-19 pandemic, these in-person PHP services were discontinued in response to public health recommendations and to ensure the safety and well-being of patients and staff. To maintain this important point along the psychiatric care continuum, hospital leadership encouraged our PHP team to pursue an alternative approach to treatment delivery: video-based telepsychotherapy. This article describes the development of a virtual PHP that serves acute psychiatric patients stepping down from inpatient hospitalization. First, we provide an overview of the original in-person PHP and then discuss the process of its transition to a virtual format. Next, we describe in detail the components of our newly developed virtual PHP, highlighting adaptations necessitated by patients and staff being remote from our physical hospital. Finally, we present preliminary evidence of our virtual PHP's acceptability and feasibility, based on experiences with our 23 patients to date; discuss lessons learned from this program development effort; and recommend future directions for research and clinical practice. Information provided herein aims to guide the development of other virtual PHPs and telepsychotherapy programs that similarly strive to offer intensive treatment to an acute psychiatric population.