The Subjective Experience of Youths at Clinically High Risk of Psychosis: A Qualitative Study

Ben‐David, Shelly; Birnbaum, Michael L.; Eilenberg, Mara; DeVylder, Jordan; Gill, Kelly E.; Schienle, Jessica; Azimov, Neyra; Lukens, Ellen P.; Davidson, Larry; Corcoran, Cheryl

doi:10.1176/appi.ps.201300527

Cited by 30 publications

(24 citation statements)

References 14 publications

(27 reference statements)

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“…Prompts queried impact of life changes experienced, and expectations for the future 18 . This dataset was used to study cross-protocol prediction accuracy.…”

Section: Nyc (Narrative-based Protocol Dataset)mentioning

confidence: 99%

Prediction of psychosis across protocols and risk cohorts using automated language analysis

et al. 2018

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Language and speech are the primary source of data for psychiatrists to diagnose and treat mental disorders. In psychosis, the very structure of language can be disturbed, including semantic coherence (e.g., derailment and tangentiality) and syntactic complexity (e.g., concreteness). Subtle disturbances in language are evident in schizophrenia even prior to first psychosis onset, during prodromal stages. Using computer-based natural language processing analyses, we previously showed that, among English-speaking clinical (e.g., ultra) high-risk youths, baseline reduction in semantic coherence (the flow of meaning in speech) and in syntactic complexity could predict subsequent psychosis onset with high accuracy. Herein, we aimed to cross-validate these automated linguistic analytic methods in a second larger risk cohort, also English-speaking, and to discriminate speech in psychosis from normal speech. We identified an automated machine-learning speech classifier -comprising decreased semantic coherence, greater variance in that coherence, and reduced usage of possessive pronouns -that had an 83% accuracy in predicting psychosis onset (intra-protocol), a cross-validated accuracy of 79% of psychosis onset prediction in the original risk cohort (cross-protocol), and a 72% accuracy in discriminating the speech of recent-onset psychosis patients from that of healthy individuals. The classifier was highly correlated with previously identified manual linguistic predictors. Our findings support the utility and validity of automated natural language processing methods to characterize disturbances in semantics and syntax across stages of psychotic disorder. The next steps will be to apply these methods in larger risk cohorts to further test reproducibility, also in languages other than English, and identify sources of variability. This technology has the potential to improve prediction of psychosis outcome among at-risk youths and identify linguistic targets for remediation and preventive intervention. More broadly, automated linguistic analysis can be a powerful tool for diagnosis and treatment across neuropsychiatry.Key words: Automated language analysis, prediction of psychosis, semantic coherence, syntactic complexity, high-risk youths, machine learning (World Psychiatry 2018;17:67-75) Language offers a privileged view into the mind: it is the basis by which we infer others' thought processes, such that disorganized language is considered to reflect disorder in thought. Language disturbance is prevalent in schizophrenia and is related to functional disability, given that an individual needs to think and speak clearly in order to maintain friends and a job 1 . In schizophrenia, the speaker "violates the syntactical and semantic conventions which govern language usage", yielding reduction in syntactic complexity (concrete speech, poverty of content) and loss of semantic coherence, e.g. the disruption in flow of meaning in language (derailment, tangentiality) 2. This language disturbance is an early core feature of sch...

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“…Prompts queried impact of life changes experienced, and expectations for the future 18 . This dataset was used to study cross-protocol prediction accuracy.…”

Section: Nyc (Narrative-based Protocol Dataset)mentioning

confidence: 99%

Prediction of psychosis across protocols and risk cohorts using automated language analysis

et al. 2018

Self Cite

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“…However, the first break of schizophrenia most commonly occurs in late adolescence or even young adulthood and will likely require special care for life. 46 Older children with attention deficit disorder may appear childlike or age appropriate depending on the setting and circumstances. 47 Clear drafting of a parenting plan will help parents overcome disagreements and make decisions in their child's best interests without delaying needed treatment or returning to court.…”

Section: Need For Flexibility and Planning Aheadmentioning

confidence: 99%

Best Interests of the Special Needs Child: Mandating Consideration of the Child's Mental Health

Mermelstein¹,

Rosen²,

Wolf³

2016

Family Court Review

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There has been a considerable increase in the number of separation and divorce cases in family court involving special needs children. However, most states do not consider the mental and physical health needs of the child in determining what is in the best interests of the child. The special needs of the child due to a mental illness or behavioral disorder must be a statutorily required factor when a court makes a custody decision and/or designs a parenting plan under the “best interests of the child” standard. The existence of a mental illness or behavioral disorder in a child presents unique challenges to the family court in determining custody and designing a parenting plan. Commonly recommended parenting plans may not be appropriate for a special needs child, especially when that child will require parental involvement beyond age eighteen. The special needs of the child due to a mental illness or behavioral disorder must be a statutorily required factor when a court makes a custody decision and/or designs a parenting plan under the “best interests of the child” standard. Family court judges can consult with clinical experts to adequately understand the child's needs and address them in the custody decision and parenting plan.

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“…For this reason, according to current textbooks, signs of trouble are often already manifest during childhood in the form of academic, social and behavioural difficulty. Premorbid signs of trouble, however, are not usually seen in women 12. This has been attributed, in part, to the protective role of fetal oestrogen in fetal development 13…”

Section: Characteristics Of Zelda's Illnessmentioning

confidence: 99%

Gendering psychosis: the illness of Zelda Fitzgerald

Seeman

2015

Med Humanities

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Psychiatric textbooks tend to describe psychosis as it is experienced by men. The well-documented illness of Zelda Fitzgerald illustrates the feminine side of psychosis. The distinctive features of Zelda's illness--its specific precipitants, the timing of its onset, the discontinuities in its course, the pronounced mood swings, the preservation of intellect and of agency, the maintenance of human ties, the association of flare-ups with immune and hormonal changes, the responsiveness to treatment, the lifelong creativity and productivity--show the female side of psychotic illness, one that is rarely described in diagnostic manuals. This paper relies on Nancy Milford's biography of Zelda, as well as on several other biographical sources and, using Zelda's own words and the words of her husband and friends, allows entry into a feminine world of psychosis, not encountered in textbooks. The expression of psychotic illness varies from person to person, its exact shape depending on many factors, most of them still undetermined, but gender is a critically important core component of variance.

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The Subjective Experience of Youths at Clinically High Risk of Psychosis: A Qualitative Study

Cited by 30 publications

References 14 publications

Prediction of psychosis across protocols and risk cohorts using automated language analysis

Prediction of psychosis across protocols and risk cohorts using automated language analysis

Best Interests of the Special Needs Child: Mandating Consideration of the Child's Mental Health

Gendering psychosis: the illness of Zelda Fitzgerald

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