Early expressions of psychopathology and risk associated with trans-diagnostic transition to mood and psychotic disorders in adolescents and young adults

Abstract

Objectives The heterogeneity and comorbidity of major mental disorders presenting in adolescents and young adults has fostered calls for trans-diagnostic research. This study examines early expressions of psychopathology and risk and trans-diagnostic caseness in a community cohort of twins and non-twin siblings. Methods Using data from the Brisbane Longitudinal Twin Study, we estimated median number of self-rated psychiatric symptoms, prevalence of subthreshold syndromes, family history of mood and/or psychotic disorders, and likelihood of subsequent trans-diagnostic caseness (individuals meeting diagnostic criteria for mood and/or psychotic syndromes). Next, we used cross-validated Chi-Square Automatic Interaction Detector (CHAID) analyses to identify the nature and relative importance of individual self-rated symptoms that predicted trans-diagnostic caseness. We examined the positive and negative predictive values (PPV; NPV) and accuracy of all classifications (Area under the Curve and 95% confidence intervals: AUC; 95% CI). Results Of 1815 participants (Female 1050, 58%; mean age 26.40), more than one in four met caseness criteria for a mood and/or psychotic disorder. Examination of individual factors indicated that the AUC was highest for subthreshold syndromes, followed by family history then self-rated psychiatric symptoms, and that NPV always exceeded PPV for caseness. In contrast, the CHAID analysis (adjusted for age, sex, twin status) generated a classification tree comprising six trans-diagnostic symptoms. Whilst the contribution of two symptoms (need for sleep; physical activity) to the model was more difficult to interpret, CHAID analysis indicated that four self-rated symptoms (sadness; feeling overwhelmed; impaired concentration; paranoia) offered the best discrimination between cases and non-cases. These four symptoms showed different associations with family history status. Conclusions The findings need replication in independent cohorts. However, the use of CHAID might provide a means of identifying specific subsets of trans-diagnostic symptoms representing clinical phenotypes that predict transition to caseness in individuals at risk of onset of major mental disorders.

Identifying self-report measures of emotion regulation and evaluating their psychometric properties: a protocol for a systematic review

“…Given the advantages of self-report instruments (eg, quick to administer, easy to score and the suitability for being used as part of a broad survey),48 we focused on these measures. This fits with the current recognised need to improve the early detection of mental health difficulties by addressing a broad range of symptoms and underlying transdiagnostic mechanisms 49 50…”

Dynamic networks of psychological symptoms, impairment, substance use, and social support: The evolution of psychopathology among emerging adults

“…The 12-item Somatic and Psychological Health Report (SPHERE-12) measured the presence/absence of somatic (SOMA-6 subscale, e.g., hypersomnia, anergia) and anxious-depressive symptoms (PSYCH-6 subscale, e.g., feeling overwhelmed, hopelessness) over recent weeks [27]. Five hypo-manic symptoms (persistence >2 days of, e.g., decreased need for sleep, feeling elated) were examined using an investigator-devised self-rating scale (used in several of our studies) [23, 24, 28]. Six psychotic-like symptoms (e.g., auditory hallucinations) were assessed using a tool adapted in part from the Community Assessment of Psychic Experiences [29].…”

“…The current study uses DBNs to examine the temporal relationships among self-rated psychological symptoms and associated social, occupational, and lifestyle factors across two waves of follow-up (~5–6-year interval) of a cohort of young people recruited to the Brisbane Longitudinal Twin Study (BLTS), a prospective, community-based study of adult twins and nontwin siblings. In a series of recent studies, we examined the progression of subthreshold syndromes (i.e., depression-like, hypo-manic-like, and psychotic-like) to full-threshold mood and psychotic disorders [23, 24]. Here, we focus on cohort members without evidence of a full-threshold disorder, and we model two DBNs to examine two questions: (a) what are the relationships among self-rated psychological symptoms, impairment, alcohol and other substance use, and perceived social support across the “Nineteen and Up” (19Up) and “Twenty Five and Up” (25Up) study waves; and (b) what are the relationships among these factors at 19Up and subsequent progression to a depression-like, hypo-manic-like, and/or psychotic-like subthreshold syndrome at 25Up?…”

A Latent Profile Analysis of Psychotic Experiences, Non-psychotic Symptoms, Suicidal Ideation and Underlying Mechanisms in a Sample of Adolescents From the General Population

“…Taking a more transdiagnostic perspective of psychopathology ( 25 , 26 ), one way to approach this is to analyze PEs in conjunction with other symptoms and vulnerability factors in clinical and non-clinical populations within the framework of the extended psychosis phenotype model ( 27 ). One technique that allows for this is latent profile analysis (LPA), a categorical latent variable modeling approach ( 28 , 29 ) allowing for classifications of individuals into latent subgroups based on their scoring patterns on a range of manifest variables.…”

“…Specifically, it has been shown that adolescents endorsing PEs use more emotional suppression and less cognitive reappraisal ( 45 ), which is in turn associated with higher comorbid symptomatology ( 46 ). However, the evidence of emotional difficulties in psychotic disorders remains mixed ( 25 , 47 ).…”