Persistence or recurrence of non-psychotic comorbid mental disorders associated with 6-year poor functional outcomes in patients at ultra high risk for psychosis

Rutigliano, Grazia; Valmaggia, Lucia; Landi, Pietro; Frascarelli, Marianna; Cappucciati, Marco; Sear, Victoria; Rocchetti, Matteo; Micheli, Andrea De; Jones, Ceri; Palombini, Erika; McGuire, Philip; Fusar‐Poli, Paolo

doi:10.1016/j.jad.2016.05.053

Cited by 125 publications

(132 citation statements)

References 68 publications

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“…Recent studies have confirmed that CHR-P individuals are not at risk for developing incident bipolar disorders, nonbipolar mood disorders or anxiety disorders 15 compared to control groups and that the vast majority of comorbid disorders observed in CHR-P individuals who do not develop psychosis is already present at the baseline. 16 These findings advance knowledge indicating that the possible outcomes specifically associated with the CHR-P (which may be preferred to the acronym "CHR" to better acknowledge the specificity for psychosis prediction) designation may include the onset of psychotic disorders, remission or persistence of initial symptoms and variable functional outcomes 17 but not an increased risk of emergence of new (incident) nonpsychotic mental disorders.…”

Section: Specificity For Psychosis Predictionmentioning

confidence: 59%

The Clinical High-Risk State for Psychosis (CHR-P), Version II

Fusar‐Poli

2017

SCHBUL

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172

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The Clinical High-Risk state for psychosis (CHR-P) paradigm was introduced about 2 decades ago. Over this period of time accumulating knowledge has been gained. Conceptual advancements involve new knowledge into risk enrichment and the impact of recruitment strategies, specificity for prediction of psychotic and nonpsychotic mental disorders and heterogeneity of psychosis risk among the different CHR-P subgroups. The current special issue advances current knowledge on deconstructing the CHR-P paradigm across its 3 subgroups: genetic risk, attenuated psychotic symptoms, and short-lived and remitting psychotic episodes. A conceptual revision of the paradigm (Version II) is suggested and supported by 3 original studies published in this special issue.

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Section: Specificity For Psychosis Predictionmentioning

confidence: 59%

The Clinical High-Risk State for Psychosis (CHR-P), Version II

Fusar‐Poli

2017

SCHBUL

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172

124

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“…It may, however, in further studies be useful to examine other outcomes such as functional outcome as it has been reported in an earlier study that individuals at CHR who did not develop psychosis during the 6-year follow-up but who were otherwise affected by one or more recurrent comorbid disorders presented with poor functional outcomes at follow-up (Rutigliano et al, 2016). …”

Section: Discussionmentioning

confidence: 99%

Comorbid diagnoses for youth at clinical high risk of psychosis

Addington

Piškulić

Liu

et al. 2017

Schizophrenia Research

101

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Several studies have demonstrated that youth at clinical high risk (CHR) of developing psychosis have a high prevalence of comorbid psychiatric disorders. Less is known about the impact of comorbid diagnoses on later conversion to psychosis and the change over time. The aim of this study was to determine the frequency and distribution of psychiatric diagnoses at baseline and over time in the North American Prodrome Longitudinal Study (NAPLS 2) and the role of comorbid diagnoses in conversion to psychosis. The NAPLS 2 sample consisted of 744 CHR youth and 276 healthy controls. Only 21% of the CHR group did not have a comorbid diagnosis with many have 2–3 DSM-IV comorbid diagnoses. The most common diagnoses were anxiety and depressive disorders, which did improve over time. The only diagnosis at baseline that differentiated the converters from the non-converters was cannabis misuse. Comorbidity, except for cannabis use, was essentially independent of clinical outcome. It is possible that those with comorbid diagnoses are preferentially the help-seeking individuals that present for help in our clinics and research projects and that those who at risk but do not have a comorbid diagnosis may not be seeking help in the prodromal phase.

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“…Around 73% of CHR individuals have at least one other Axis I disorder (89). Long-term studies show persistence of comorbid disorders such as mood (15–38%), anxiety (5–16%), substance use (11%), personality disorders (2.7%), and other diagnoses (43–52%) (91, 92). At a 6-year follow-up, approximately 56.8% of CHR patients endorsed at least one comorbid disorder and 61.5% of them reported continued comorbidity from baseline (91).…”

Section: Comorbid Disorders and Differential Diagnosis In The Chr Popmentioning

confidence: 99%

“…Long-term studies show persistence of comorbid disorders such as mood (15–38%), anxiety (5–16%), substance use (11%), personality disorders (2.7%), and other diagnoses (43–52%) (91, 92). At a 6-year follow-up, approximately 56.8% of CHR patients endorsed at least one comorbid disorder and 61.5% of them reported continued comorbidity from baseline (91). Only a small group of CHR individuals (7–16%) reported no comorbid diagnoses at baseline or follow-up (91, 92).…”

Section: Comorbid Disorders and Differential Diagnosis In The Chr Popmentioning

confidence: 99%

“…At a 6-year follow-up, approximately 56.8% of CHR patients endorsed at least one comorbid disorder and 61.5% of them reported continued comorbidity from baseline (91). Only a small group of CHR individuals (7–16%) reported no comorbid diagnoses at baseline or follow-up (91, 92). Clearly, comorbidity is the rule and not the exception when dealing with EP symptomatology.…”

Section: Comorbid Disorders and Differential Diagnosis In The Chr Popmentioning

confidence: 99%

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The Role of Trauma and Stressful Life Events among Individuals at Clinical High Risk for Psychosis: A Review

et al. 2017

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The experience of childhood trauma (CT) and stressful life events (SLEs) is associated with subsequent development of a variety of mental health conditions, including psychotic illness. Recent research identifying adolescents and young adults at clinical high risk (CHR) for psychosis allows for prospective evaluation of the impact of trauma and adverse life events on psychosis onset and other outcomes, addressing etiological questions that cannot be answered in studies of fully psychotic or non-clinical populations. This article provides a comprehensive review of the current emerging literature on trauma and adverse life events in the CHR population. Up to 80% of CHR youth endorse a lifetime history of childhood traumatic events and victimization (e.g., bullying). Several studies have shown that the experience of CT predicts psychosis onset among CHR individuals, while the literature on the influence of recent SLEs (e.g., death of a loved one) remains inconclusive. Multiple models have been proposed to explain the link between trauma and psychosis, including the stress-vulnerability and stress-sensitivity hypotheses, with emphases on both cognitive processes and neurobiological mechanisms (e.g., the hypothalamic–pituitary–adrenal axis). Despite the preponderance of CHR individuals who endorse either CT or SLEs, no clinical trials have been conducted evaluating interventions for trauma in CHR youth to date. Furthermore, the current process of formal identification and assessment of trauma, SLEs, and their impact on CHR youth is inconsistent in research and clinical practice. Recommendations for improving trauma assessment, treatment, and future research directions in the CHR field are provided.

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Persistence or recurrence of non-psychotic comorbid mental disorders associated with 6-year poor functional outcomes in patients at ultra high risk for psychosis

Abstract: Among UHR patients, persistence or recurrence of non-psychotic comorbid mental disorders, mostly affective disorders, is associated with 6-year poor functional outcomes.

Cited by 125 publications

References 68 publications

The Clinical High-Risk State for Psychosis (CHR-P), Version II

The Clinical High-Risk State for Psychosis (CHR-P), Version II

Comorbid diagnoses for youth at clinical high risk of psychosis

The Role of Trauma and Stressful Life Events among Individuals at Clinical High Risk for Psychosis: A Review

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