Clinical Validity of<i>DSM-5</i>Attenuated Psychosis Syndrome

Pablo, Gonzalo Salazar de; Catalán, Ana; Fusar‐Poli, Paolo

doi:10.1001/jamapsychiatry.2019.3561

Cited by 82 publications

(60 citation statements)

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“…When psychotic-like experiences persist and are associated with distress or impairment, they are thought to represent a meaningful diagnostic entity known as the "clinical high-risk for psychosis (CHR) syndrome," sometimes referred to as "attenuated" or "prodromal" psychosis 19 . Even though the CHR syndrome progresses to frank SCZ in just one-fourth of cases within 36 months of its identification 20 , CHR youth who do not progress continue to have pronounced social and cognitive impairment 21 and may benefit from specialized attention.…”

Section: Introductionmentioning

confidence: 99%

Reported autism diagnosis strongly predicts psychotic-like experiences in the Adolescent Brain Cognitive Development cohort

Jutla¹,

Donohue²,

Veenstra‐VanderWeele

et al. 2020

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Although the schizophrenia rate is increased in autism spectrum disorder (ASD), it is difficult to identify which youth with ASD will go on to develop psychosis. We explored the relationship between ASD and emerging psychotic-like experiences in the Adolescent Brain Cognitive Development (ABCD) cohort of school-aged children. We predicted that ASD would robustly predict psychotic-like experience severity, even relative to other established predictors, and that ASD youth with psychotic-like experiences would have a characteristic neurocognitive profile. In a sample of 9,130 youth aged 9-11, we fit regression models that included parent-reported ASD, family history of psychosis, lifetime trauma, executive function, processing speed, working memory, age, sex, race, ethnicity, and income-to-needs ratio as predictors of Prodromal Questionnaire - Brief Child (PQ-BC) score. We assessed cognitive profiles using analysis of variance on NIH Toolbox measures. ASD increased PQ-BC distress scores by 2.46 points (95% CI 1.32 - 3.60), an effect at least as large as those of family history of psychosis (1.05 points, 95% CI 0.56 - 1.53), Latinx ethnicity (0.99 points, 95% CI 0.52 - 1.45) and black race (0.89 points, 95% CI 0.30 - 1.48). We did not identify a unique cognitive profile for ASD youth with psychotic-like experiences. Our finding that ASD predicts psychotic-like symptoms in youth is consistent with previous literature, and adds new information in suggesting that ASD is a strong predictor of psychotic-like experiences even when compared to other established SCZ risk factors.

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Section: Introductionmentioning

confidence: 99%

Reported autism diagnosis strongly predicts psychotic-like experiences in the Adolescent Brain Cognitive Development cohort

Jutla¹,

Donohue²,

Veenstra‐VanderWeele

et al. 2020

Preprint

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“…In the SIPS, the characterization used is Attenuated Positive Symptoms Syndrome (APSS). Seven years ago, the DSM-5 introduced the Attenuated Psychosis Syndrome (APS) diagnosis in the research appendix, listed in both section II and section III (21) (Figure 1). This diagnosis is defined by the presence of delusions, hallucinations, or disorganized speech in attenuated form, but with sufficient severity and frequency to warrant clinical attention (23,24) (Figure 1).…”

Section: Introductionmentioning

confidence: 99%

“…This diagnosis is defined by the presence of delusions, hallucinations, or disorganized speech in attenuated form, but with sufficient severity and frequency to warrant clinical attention (23,24) (Figure 1). The diagnostic, prognostic, and therapeutic characteristics of this diagnosis have been recently appraised by a systematic review and meta-analysis (21). This review concluded that DSM-5-APS criteria have received substantial concurrent and prognostic validation, mostly driven by research in adult populations (21).…”

Section: Introductionmentioning

confidence: 99%

“…The diagnostic, prognostic, and therapeutic characteristics of this diagnosis have been recently appraised by a systematic review and meta-analysis (21). This review concluded that DSM-5-APS criteria have received substantial concurrent and prognostic validation, mostly driven by research in adult populations (21). A previous study looking at the agreement between CAARMS and DSM-5-APS criteria found that the agreement was only moderate (kappa 0.59) (25).…”

Section: Introductionmentioning

confidence: 99%

“…While most reports to date on APS are based on cohorts that also include adults (25,(28)(29)(30), APS features often occur for the first time in adolescence (31,32). Broadly speaking, studies that focus on DSM-5-APS in adolescents are scarce (21,22), and there are few studies on APS in adolescents in clinical care and hospital settings.…”

Section: Introductionmentioning

confidence: 99%

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DSM-5 Attenuated Psychosis Syndrome in Adolescents Hospitalized With Non-psychotic Psychiatric Disorders

et al. 2020

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Introduction: Although attenuated psychotic symptoms often occur for the first time during adolescence, studies focusing on adolescents are scarce. Attenuated psychotic symptoms form the criteria to identify individuals at increased clinical risk of developing psychosis. The study of individuals with these symptoms has led to the release of the DSM-5 diagnosis of Attenuated Psychosis Syndrome (APS) as a condition for further research. We aimed to characterize and compare hospitalized adolescents with DSM-5-APS diagnosis vs. hospitalized adolescents without a DSM-5-APS diagnosis. Methods: Interviewing help-seeking, hospitalized adolescents (aged 12-18 years) and their caregivers independently with established research instruments, we (1) evaluated the presence of APS among non-psychotic adolescents, (2) characterized and compared APS and non-APS individuals regarding sociodemographic, illness and intervention characteristics, (3) correlated psychopathology with levels of functioning and severity of illness and (4) investigated the influence of individual clinical, functional and comorbidity variables on the likelihood of participants to be diagnosed with APS. Results: Among 248 consecutively recruited adolescents (age=15.4 ± 1.5 years, females = 69.6%) with non-psychotic psychiatric disorders, 65 (26.2%) fulfilled APS criteria and 183 (73.8%) did not fulfill them. Adolescents with APS had higher number Salazar de Pablo et al. DSM-5 Attenuated Psychosis Syndrome in Adolescents of psychiatric disorders than non-APS adolescents (3.5 vs. 2.4, p < 0.001; Cohen's d = 0.77), particularly, disruptive behavior disorders (Cramer's V = 0.16), personality disorder traits (Cramer's V = 0.26), anxiety disorders (Cramer's V = 0.15), and eating disorders (Cramer's V = 0.16). Adolescents with APS scored higher on positive (Cohen's d = 1.5), negative (Cohen's d = 0.55), disorganized (Cohen's d = 0.51), and general symptoms (Cohen's d = 0.84), and were more severely ill (Cohen's d = 1.0) and functionally impaired (Cohen's d = 0.31). Negative symptoms were associated with lower functional levels (Pearson ρ = −0.17 to −0.20; p = 0.014 to 0.031). Global illness severity was associated with higher positive, negative, and general symptoms (Pearson ρ = 0.22 to 0.46; p = 0.04 to p < 0.001). APS status was independently associated with perceptual abnormalities (OR = 2.0; 95% CI = 1.6-2.5, p < 0.001), number of psychiatric diagnoses (OR = 1.5; 95% CI = 1.2-2.0, p = 0.002), and impaired stress tolerance (OR = 1.4; 95% CI = 1.1-1.7, p = 0.002) (r 2 = 0.315, p < 0.001). Conclusions: A considerable number of adolescents hospitalized with non-psychotic psychiatric disorders meet DSM-5-APS criteria. These help-seeking adolescents have more comorbid disorders and more severe symptoms, functional impairment, and severity of illness than non-APS adolescents. Thus, they warrant high intensity clinical care.

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Prevention of Psychosis

et al. 2020

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IMPORTANCE Detection, prognosis, and indicated interventions in individuals at clinical high risk for psychosis (CHR-P) are key components of preventive psychiatry. OBJECTIVE To provide a comprehensive, evidence-based systematic appraisal of the advancements and limitations of detection, prognosis, and interventions for CHR-P individuals and to formulate updated recommendations. EVIDENCE REVIEW Web of Science, Cochrane Central Register of Reviews, and Ovid/PsychINFO were searched for articles published from January 1, 2013, to June 30, 2019, to identify meta-analyses conducted in CHR-P individuals. MEDLINE was used to search the reference lists of retrieved articles. Data obtained from each article included first author, year of publication, topic investigated, type of publication, study design and number, sample size of CHR-P population and comparison group, type of comparison group, age and sex of CHR-P individuals, type of prognostic assessment, interventions, quality assessment (using AMSTAR [Assessing the Methodological Quality of Systematic Reviews]), and key findings with their effect sizes.FINDINGS In total, 42 meta-analyses published in the past 6 years and encompassing 81 outcomes were included. For the detection component, CHR-P individuals were young (mean [SD] age, 20.6 [3.2] years), were more frequently male (58%), and predominantly presented with attenuated psychotic symptoms lasting for more than 1 year before their presentation at specialized services. CHR-P individuals accumulated several sociodemographic risk factors compared with control participants. Substance use (33% tobacco use and 27% cannabis use), comorbid mental disorders (41% with depressive disorders and 15% with anxiety disorders), suicidal ideation (66%), and self-harm (49%) were also frequently seen in CHR-P individuals. CHR-P individuals showed impairments in work (Cohen d = 0.57) or educational functioning (Cohen d = 0.21), social functioning (Cohen d = 1.25), and quality of life (Cohen d = 1.75). Several neurobiological and neurocognitive alterations were confirmed in this study. For the prognosis component, the prognostic accuracy of CHR-P instruments was good, provided they were used in clinical samples. Overall, risk of psychosis was 22% at 3 years, and the risk was the highest in the brief and limited intermittent psychotic symptoms subgroup (38%). Baseline severity of attenuated psychotic (Cohen d = 0.35) and negative symptoms (Cohen d = 0.39) as well as low functioning (Cohen d = 0.29) were associated with an increased risk of psychosis. Controlling risk enrichment and implementing sequential risk assessments can optimize prognostic accuracy. For the intervention component, no robust evidence yet exists to favor any indicated intervention over another (including needs-based interventions and control conditions) for preventing psychosis or ameliorating any other outcome in CHR-P individuals. However, because the uncertainty of this evidence is high, needs-based and psychological interventions should still be offered. CONCL...

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Clinical Validity ofDSM-5Attenuated Psychosis Syndrome

Cited by 82 publications

References 110 publications

Reported autism diagnosis strongly predicts psychotic-like experiences in the Adolescent Brain Cognitive Development cohort

Reported autism diagnosis strongly predicts psychotic-like experiences in the Adolescent Brain Cognitive Development cohort

DSM-5 Attenuated Psychosis Syndrome in Adolescents Hospitalized With Non-psychotic Psychiatric Disorders

Prevention of Psychosis

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