Psychotic conversion of individuals at ultra‐high risk for psychosis: The potential roles of schizotypy and basic symptoms

Bang, Minji; Park, Jin Y.; Kim, Kyung Ran; Lee, Su Young; Song, Yoo Sung; Kang, Jee In; Lee, Eun; An, Suk Kyoon

doi:10.1111/eip.12518

Cited by 24 publications

(20 citation statements)

References 48 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This finding was compatible with previous studies showing that low neurocognitive performance predicts higher conversion rate in the UHR group (29). In contrast to previous studies (31, 39), other factors failed to predict conversion. Among the social cognitive measures, we used AIHQ to measure social cognitive bias; however, previous studies suggested that the theory of mind, among social cognition, was related to conversion in the high-risk group (31).…”

Section: Discussioncontrasting

confidence: 99%

“…The pre-reflective self factor score was significantly lower in the HC group than in the other two groups. Considering the high loadings of magical ideation, perceptual aberration, and basic symptoms of the pre-reflective self factor, the higher scores in the clinical groups were reasonable and compatible with previous studies showing higher basic symptoms and schizotypy scores in individuals at UHR for psychosis (39). Higher factor scores in the UHR and ROSPR groups are consistent with the concept that the basic symptoms of schizophrenia allow the identification of the earliest-experienced subjective symptoms (76).…”

Section: Discussionsupporting

confidence: 90%

“…One study suggested the predictive value of schizotypy; however, among the subscores, only physical anhedonia predicted conversion in the high-risk group (81). Another study failed to demonstrate basic symptoms and schizotypy as predicting factors for conversion when using combined variables (39). Further research is needed to determine the different effects of each component for predicting conversion.…”

Section: Discussionmentioning

confidence: 99%

“…Conversely, the conversion rate is higher in low-resilience patients (38). Basic symptoms and schizotypy of physical anhedonia are other predicting factors of conversion in individuals at UHR for psychosis (39).…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Factors Associated With Psychosocial Functioning and Outcome of Individuals With Recent-Onset Schizophrenia and at Ultra-High Risk for Psychosis

et al. 2019

Self Cite

View full text Add to dashboard Cite

Background: Patients with schizophrenia have impairments in social functioning and are readmitted to healthcare institutions frequently. Individuals at ultra-high risk (UHR) for psychosis already present poor social functioning; among those individuals, the conversion rate from the putative prodromal phase to overt psychosis is 20%–30% within 1–2 years. Here, we analyzed the factor structure of self-related variables and neuro- and socio-cognitive function, and investigated whether these factors were associated with psychosocial function and prognostic outcome in individuals with recent-onset schizophrenia (ROSPR) or at UHR for psychosis. Methods: We evaluated 60 individuals at UHR for psychosis, 47 individuals with ROSPR, and 71 healthy controls using a comprehensive neurocognitive test battery and self-reported attribution scales, self-esteem, resilience, aberrant subjective experiences of schizotypy (physical anhedonia, social anhedonia, magical ideation, and perceptual aberration), and basic symptoms. We assessed psychosocial function with the Quality of Life Scale (QLS). Results: Factor analysis of all subjects revealed a four-factor structure comprising social-cognitive bias, reflective self, neurocognition, and pre-reflective self factors. Multiple regression analysis at baseline revealed that the factor structure predicted QLS. In the UHR group, social-cognitive bias, reflective self, neurocognition, and negative symptoms were significant determinants, explaining 38.0% of total QLS score variance. In the ROSPR group, reflective self and negative symptoms were significant determinants, explaining 54.4% of total QLS score variance. During follow-up, 13 individuals at UHR for psychosis developed psychosis (cumulative prevalence: 31.2% ± 7.6% at 6 years), with neurocognition score at baseline remaining a significant predictor of conversion [χ 2 (1) = 4.009, p = 0.045; hazard ratio 0.56, 95% confidence interval 0.31–0.99, p = 0.048]. Five patients with schizophrenia were (re)admitted during follow-up (cumulative prevalence: 16.1% ± 7.1% at 6 years); no factor was found to predict (re)admission. Conclusion: Factor analysis revealed an intrinsic four-factor structure of social-cognitive bias, reflective self, neurocognition, and pre-reflective self. The four factors were associated with social functioning at baseline and prodrome-to-psychosis conversion during follow-up, indicating the clinical significance of the four-factor structure. These findings provide a framework for understanding schizophrenia.

show abstract

Section: Discussioncontrasting

confidence: 99%

Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Factors Associated With Psychosocial Functioning and Outcome of Individuals With Recent-Onset Schizophrenia and at Ultra-High Risk for Psychosis

et al. 2019

Self Cite

View full text Add to dashboard Cite

show abstract

“…Studies using positive and negative schizotypy assessments, such as the four Wisconsin Schizotypy Scales (65, 66), suggest that pronounced physical anhedonia enhances risk for psychosis, though likely only in the presence of CHR states (67, 68); moreover, physical anhedonia also predicted presence of UHR but not of basic symptom criteria (67).…”

Section: Early Detection Of Psychotic Disordersmentioning

confidence: 99%

Psychosis and Schizophrenia-Spectrum Personality Disorders Require Early Detection on Different Symptom Dimensions

2019

View full text Add to dashboard Cite

Psychotic disorders and schizophrenia-spectrum personality disorders (PD) with psychotic/psychotic-like symptoms are considerably linked both historically and phenomenologically. In particular with regard to schizotypal and schizotypal personality disorder (SPD), this is evidenced by their placement in a joint diagnostic category of non-affective psychoses in the InternationaI Classification of Diseases 10th Revision, (CD-10) and, half-heartedly, the fifth edition of Diagnostic and Statistical Manual of Mental Disorders, (DSM-5). Historically, this close link resulted from observations of peculiarities that resembled subthreshold features of psychosis in the (premorbid) personality of schizophrenia patients and their biological relatives. These personality organizations were therefore called “borderline (schizophrenia)” in the first half of the 20th century. In the 1970s, they were renamed to “schizotypal” and separated from psychotic disorders on axis-I and from other PD on axis-II, including modern borderline PD, in the DSM. The phenomenological and historical overlap, however, has led to the common assumption that the main difference between psychotic disorders and SPD in particular was mainly one of severity or trajectory, with SPD representing a latent form of schizophrenia and/or a precursor of psychosis. Thus, psychosis proneness and schizotypy are often assessed using SPD questionnaires. In this perspective-piece, we revisit these assumptions in light of recent evidence. We conclude that schizotypy, SPD (and other schizophrenia-spectrum PD) and psychotic disorder are not merely states of different severity on one common but on qualitatively different dimensions, with the negative dimension being predictive of SPD and the positive of psychosis. Consequently, in light of the merits of early diagnosis, the differential early detection of incipient psychosis and schizophrenia-spectrum PD should be guided by the assessment of different schizotypy dimensions.

show abstract

Baseline Antipsychotic Dose and Transition to Psychosis in Individuals at Clinical High Risk

Raballo,

Poletti,

Preti

2024

JAMA Psychiatry

View full text Add to dashboard Cite

ImportanceEmerging meta-analytical evidence indicates that baseline exposure to antipsychotics is associated with an increased risk of transitioning to psychosis in individuals at clinical high-risk for psychosis (CHR-P) and that such effect is not a result of pretest risk enrichment. However, to maximize its translational utility for prognostic stratification in clinical practice, testing for the potential presence of a dose-response association is crucial.ObjectiveTo test whether the negative prognostic effect of baseline antipsychotic exposure in individuals at CHR-P follows a dose-effect pattern, as indicated by mean chlorpromazine equivalent doses (CPZ-ED).Data SourcesMEDLINE and Cochrane Library, performed up to August 31, 2023, searching for English-language studies on individuals at CHR-P reporting data on exposure to antipsychotics at baseline and detailed information on dosage by transition status.Study SelectionStudies that provided information on antipsychotic exposure at baseline and included detailed dosage data categorized by transition status.Data Extraction and SynthesisEligible studies were identified following PRISMA guidelines and evaluated independently by 2 reviewers with the Newcastle-Ottawa Scale for assessing the quality of nonrandomized studies in meta-analyses.Main Outcomes and MeasuresThe primary outcome was transition to psychosis in individuals at CHR-P who were receiving antipsychotic treatment at baseline, measured by baseline mean CPZ-ED in individuals at CHR-P who transitioned to psychosis compared to those who did not.ResultsEight studies were included in the systematic review and meta-analysis. Among 290 individuals at CHR-P (mean [SD] age, 19.4 [2.6] years) who were exposed to antipsychotics at baseline and remained in contact up to the completion of the study, 66 converted to psychosis and 224 did not. The mean CPZ-ED ranged 60 to 395 mg/d in those who converted and 13 to 224 mg/d in those who did not. Those who converted to psychosis had higher CPZ-ED than those who did not in both the common-effects model (Hedges g, 0.41; 95% CI, 0.12-0.70; z, 2.78; P = .005) and in the random-effects model (Hedges g, 0.41; 95% CI, 0.15-0.67; z, 3.69; P = .008; τ2, 0.0). There was no relevant heterogeneity (Cochran Q, 3.99; df, 7; P = .78; I2, 0.0%; 95% CI, 0.0-68.0). The radial plot indicated a good fit of the model.Conclusions and RelevanceIn individuals at CHR-P who were exposed to antipsychotics at baseline, those receiving higher antipsychotic doses demonstrated an increased likelihood of transitioning to psychosis. This meta-analytic evidence of putative dose-effect association confirms that baseline antipsychotic exposure and the corresponding dosage carry salient prognostic information that could improve current CHR-P criteria-based risk stratification at inception.

show abstract

Psychotic conversion of individuals at ultra‐high risk for psychosis: The potential roles of schizotypy and basic symptoms

Cited by 24 publications

References 48 publications

Factors Associated With Psychosocial Functioning and Outcome of Individuals With Recent-Onset Schizophrenia and at Ultra-High Risk for Psychosis

Factors Associated With Psychosocial Functioning and Outcome of Individuals With Recent-Onset Schizophrenia and at Ultra-High Risk for Psychosis

Psychosis and Schizophrenia-Spectrum Personality Disorders Require Early Detection on Different Symptom Dimensions

Baseline Antipsychotic Dose and Transition to Psychosis in Individuals at Clinical High Risk

Contact Info

Product

Resources

About