Comorbid diagnoses for youth at clinical high risk of psychosis

Addington, Jean; Piškulić, Danijela; Liu, Lu; Lockwood, Jonathan; Cadenhead, Kristin S.; Cannon, Tyrone D.; Cornblatt, Barbara A.; McGlashan, Thomas H.; Perkins, Diana O.; Seidman, Larry J.; Tsuang, Ming T.; Walker, Elaine F.; Bearden, Carrie E.; Mathalon, Daniel H.; Woods, Scott W.

doi:10.1016/j.schres.2017.03.043

Cited by 104 publications

(74 citation statements)

References 25 publications

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“…Given the fact that non‐psychotic disorders are highly prevalent among individuals with CHR and likely to influence the longitudinal outcomes 48‐50 , we estimated the risk attributable to these disorders in the subpopulation of participants with psychosis high‐risk state. The joint PAF for all non‐psychotic mental disorders was noteworthy but still lower than the individual PAF for psychosis high‐risk state when everything else remained the same in this subpopulation.…”

Section: Discussionmentioning

confidence: 99%

Association of preceding psychosis risk states and non‐psychotic mental disorders with incidence of clinical psychosis in the general population: a prospective study in the NEMESIS‐2 cohort

et al. 2020

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The validity and clinical utility of the concept of “clinical high risk” (CHR) for psychosis have so far been investigated only in risk‐enriched samples in clinical settings. In this population‐based prospective study, we aimed – for the first time – to assess the incidence rate of clinical psychosis and estimate the population attributable fraction (PAF) of that incidence for preceding psychosis risk states and DSM‐IV diagnoses of non‐psychotic mental disorders (mood disorders, anxiety disorders, alcohol use disorders, and drug use disorders). All analyses were adjusted for age, gender and education. The incidence rate of clinical psychosis was 63.0 per 100,000 person‐years. The mutually‐adjusted Cox proportional hazards model indicated that preceding diagnoses of mood disorders (hazard ratio, HR=10.67, 95% CI: 3.12‐36.49), psychosis high‐risk state (HR=7.86, 95% CI: 2.76‐22.42) and drug use disorders (HR=5.33, 95% CI: 1.61‐17.64) were associated with an increased risk for clinical psychosis incidence. Of the clinical psychosis incidence in the population, 85.5% (95% CI: 64.6‐94.1) was attributable to prior psychopathology, with mood disorders (PAF=66.2, 95% CI: 33.4‐82.9), psychosis high‐risk state (PAF=36.9, 95% CI: 11.3‐55.1), and drug use disorders (PAF=18.7, 95% CI: –0.9 to 34.6) as the most important factors. Although the psychosis high‐risk state displayed a high relative risk for clinical psychosis outcome even after adjusting for other psychopathology, the PAF was comparatively low, given the low prevalence of psychosis high‐risk states in the population. These findings provide empirical evidence for the “prevention paradox” of targeted CHR early intervention. A comprehensive prevention strategy with a focus on broader psychopathology may be more effective than the current psychosis‐focused approach for achieving population‐based improvements in prevention of psychotic disorders.

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Section: Discussionmentioning

confidence: 99%

Association of preceding psychosis risk states and non‐psychotic mental disorders with incidence of clinical psychosis in the general population: a prospective study in the NEMESIS‐2 cohort

et al. 2020

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“…However, PEs accompanied by high levels of negative affect and anxiety (28) that are distressing in nature and/or persistent over time can be associated with a substantial increase in risk for clinical psychosis [at least 10-fold (27)]. Also, individuals with an elevated risk for psychosis are also at greater risk for other forms of psychopathology and poor overall functioning (29,30). Thus, youth with a combination of PEs and affective symptoms represent one definable group with an increased liability for developing a serious mental illness.…”

Section: Introductionmentioning

confidence: 99%

Rationale, Methods, Feasibility, and Preliminary Outcomes of a Transdiagnostic Prevention Program for At-Risk College Students

et al. 2020

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Purpose: Early adulthood represents one period of increased risk for the emergence of a serious mental illness. The college campus provides a unique opportunity to assess and monitor individuals in this at-risk age group. However, there are no validated early detection programs that are widely implemented on college campuses. In an effort to address this gap, we designed and tested an early detection and prevention program tailored to college students. A transdiagnostic approach was employed because of evidence for shared risk factors across major mental illnesses. Design: Single arm, prospective study evaluating outcomes following a 4-week intervention. Method: Three in-person mental health screenings were conducted on the campus of one university. Undergraduate students with at least mildly elevated, self-reported levels of depressive or subclinical psychotic symptoms, who were not receiving treatment for these symptoms, were invited to participate in a 4-session workshop focused on increasing self-and other-awareness and emotion regulation using established mindfulness, self-compassion, and mentalization principles and experiential exercises. Symptoms, resilience-promoting capacities, and aspects of social functioning were assessed pre-and post-intervention. Results: 416 students were screened and a total of 63 students participated in the workshop. 91% attended at least 3 of the 4 sessions. The majority of participants found the workshop interesting and useful and would recommend it to a friend. Significant preto-post reductions in symptoms (depression, anxiety, and subclinical psychotic symptoms, ps < 0.004) and improvements in resilience-promoting capacities (selfcompassion and self-efficacy, ps < 0.006) and indices of social functioning (social motivation, activity, and a measure of comfort with the physical presence of others, ps < 0.04) were observed. Moreover, the significant increases in resilience-promoting capacities correlated with the reductions in affective symptoms (ps < 0.03).

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“…(Addington et al, 2015). Prevalence of other clinical diagnoses in UHR was similar for mood disorders (44.4% vs 49.2%) but not for anxiety disorders, which was lower in our sample (14.8% vs 47.8%; Addington et al, 2017). Regarding treatment, we were more prone to use a SGA (85.2% vs 12.3%) than psychotherapy (62.9% vs 73.7%) (Cadenhead et al, 2010).…”

Section: Discussionmentioning

confidence: 50%

Early psychosis detection program in Chile: A first step for the South American challenge in psychosis research

Gaspar

Castillo

Maturana

et al. 2018

Early Intervention Psych

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Aim Early detection and intervention (EDI) is a main challenge in psychosis research. The Chilean schizophrenia (SZ) national program has universal support and treatment by law for all SZ patients, but this does not yet extend to earlier stages of illness. Therefore, we have piloted an ultra‐high risk (UHR) program to demonstrate the utility and feasibility of this public health approach in Chile. Methods We introduce “The University of Chile High‐risk Intervention Program,” which is the first national EDI program for UHR youths. Longitudinal follow‐up included clinical and cognitive assessments, and monitoring of physiological sensory and cognitive indices, through electroencephalographic techniques. Results We recruited 27 UHR youths over 2 years. About 92.6% met criteria for attenuated psychosis syndrome (APS). Mean Scale of Psychosis‐Risk Symptoms (SOPS) ratings in the cohort were 6.9 (SD 4.6) for positive, 9.1 (SD 8.3) for negative, 5.4 (SD 5.3) for disorganized and 6.3 (SD 4.1) for general symptoms. About 14.8% met criteria for comorbid anxiety disorders and 44.4% for mood disorders. Most participants received cognitive behavioural therapy (62.9%) and were prescribed low dose antipsychotics (85.2%). The transition rate to psychosis was 22% within 2 years. Conclusions We describe our experience in establishing the first EDI program for UHR subjects in Chile. Our cohort is similar in profile and risk to those identified in higher‐income countries. We will extend our work to further optimize psychosocial and preventive interventions, to promote its inclusion in the Chilean SZ national program and to establish a South American collaboration network for SZ research.

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Comorbid diagnoses for youth at clinical high risk of psychosis

Cited by 104 publications

References 25 publications

Association of preceding psychosis risk states and non‐psychotic mental disorders with incidence of clinical psychosis in the general population: a prospective study in the NEMESIS‐2 cohort

Association of preceding psychosis risk states and non‐psychotic mental disorders with incidence of clinical psychosis in the general population: a prospective study in the NEMESIS‐2 cohort

Rationale, Methods, Feasibility, and Preliminary Outcomes of a Transdiagnostic Prevention Program for At-Risk College Students

Early psychosis detection program in Chile: A first step for the South American challenge in psychosis research

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