Search

Introduction In addition to the psychosis onset, patients at clinical high-risk (CHR) show a decrease of functioning. This may not be related to the degree and persistence of the attenuated positive symptom (APS). Other clinical factors also predict the level of remission. Objectives Revealing the predictors of the functioning in the 5-year follow-up in patients at CHR. Methods 124 young depressive patients at CHR were examined. Depression symptoms were assessed on the HDRS scale, and the CHR symptoms were assessed on the SOPS scale. The follow-up examination was conducted after 5 years with the determination of functioning on the PSP scale. A correlative analysis of the predictors of the level of remission was conducted. Results The functioning level was inversely related to the length of a depressive episode with the CHR symptoms (r=-0,432, p˂0.05), to the negative sub-scale SOPS score (r=0.312, p˂0.05) and to the symptoms of disorganization sub-scale SOPS score (r=0.246, p˂0.05) in the primary assessment. Insufficient reduction of the positive, negative symptoms and symptoms of disorganization on the SOPS during in-patient treatment was also a predictor of the worst outcome at the 5-year follow-up (r=-0,206, p˂0,05; r=-0,309, p˂0,05; r=-0,355, p˂0,05, and r=-0,349, p˂0,05, respectively). Conclusions There are some factors, except the severity of APS, that may be considered as the predictors of functioning level in patients at CHR. Disclosure No significant relationships.

Introduction The clinical high-risk for psychosis (CHR) is mainly established by the presence of attenuated positive symptoms (APS), but there is evidence of the role of attenuated negative symptoms (ANS) in the development of psychotic spectrum disorders. It is important to establish a link between APS and ANS in patients at CHR in order to improve early detection of psychosis. Objectives Establish the relationship between APS and ANS in depressive patients at CHR. Methods 130 depressive young in-patients at CHR with APS (average age 19.5) and 71 ones with ANS (average age 19.5) were examined. The HDRS scale was used to assess depressive symptoms, the SOPS scale was used to assess APS and ANS, and the SANS scale was used to assess ANS. The results are presented in median values. Results No differences were found between two groups in the severity of depressive symptoms on the HDRS scale and CHR symptoms on the SOPS scale (22 vs 23.5 and 45 vs 43 respectively). Statistically valid differences have been established between the groups in the APS severity on the sub-scale of positive symptoms SOPS: 11 and 7 (p 0.001). No differences in the ANS severity on the sub-scale of negative symptoms were detected (17 and 18.5, p=0.207). There were also no differences in the ANS severity on the SANS scale (40 and 47, p=0.163). Conclusions It has been established that patients at CHR with APS also have ANS, which may have clinical significance for early detection of psychosis. Disclosure No significant relationships.

Introduction Early detection of psychosis is a promising area in preventive psychiatry. The use of early intervention can prevent the first episode psychosis and improve outcomes. Objectives Identification of premorbid features of depressive patients at clinical high risk for psychosis (CHR) comparing with depressive patients without CHR in order to improve early recognition of the psychotic process. Methods 219 young depressive in-patients with CHR criteria for SOPS with attenuated positive and attenuated negative symptoms and 52 young depressive in-patients without CHR were examined. Presence of obstetric complications, neurodevelopmental deviance, neurological and psychiatric signs at the premorbid stage, and the level of premorbid functioning on the PAS were examined. Results It has been established that depressive patients at CHR and without CHR had some obstetric complications (57.5% and 40.4%, respectively). Neurodevelopmental deviance in the first year of live was in 57.5% patients with CHR. At the age of 3-5 sleep disorders, ADHD and phobias were more common in patients at CHR than without it (58.8% and 32.7%, p=0.014). In pubertal, patients at CHR were more likely to show depression symptoms, obsessions, and aggression - 90.4% versus 76.9% (p=0.029). On the PAS scale, a decrease of the level of premorbid functioning has been observed in two groups of patients with and without CHR from the age of 12: from 12 to 15 years, 0.4 and 0.3 (p=0.004), from 16 to 18 years, 0.47 and 0.37 (p 0.001). Conclusions Premorbid functioning were worst in patients with CHR, which indicates the possibility of early clinical detection of psychosis. Disclosure No significant relationships.

Introduction At present, there is no universally approach to treating patients at clinical high-risk for psychosis (CHR) without comorbid mental disorders. However, if there are revealed depressive symptoms, proper treatment becomes necessary. Objectives Establish pharmacological classes and doses of drugs that have proved effective in treating depressive patients at CHR. Methods A comparative study of pharmacological classes and doses of drugs was carried out, showing the effectiveness in treatment of 219 depressive patients at CHR and 52 depressive patients without CHR. The treatment effectiveness was carried out on the reduction of depression symptoms on the HDRS scale, and the CHR symptoms on the SOPS scale. Results A significant reduction of depression symptoms was achieved in the group of depressive patients with and without CHR on the HDRS scale (67.9% and 76.6% respectively). The reductions of the CHR symptoms were 46.1% and 53.3% respectively. There were differences between the severity of depression symptoms and CHR symptoms before and after the treatment. Both groups used antidepressants followed by the prescription of antipsychotics to increase the effectiveness of the therapy. No difference was found in the doses of antidepressants for the fluoxetine equivalent (46.0 vs 42.6 mg per day, p 0.05) and some differences were found for the average effective doses of antipsychotics for the chlorpromazine equivalent (385.4 vs 230.8 mg per day, p 0.05). Conclusions The same pharmacological classes are used for the treatment of young depressive patients with and without CHR, but the former have significantly higher doses of antipsychotics. Disclosure No significant relationships.

Prodromal symptoms may precede onset of the psychotic disorders by years, and while we have instruments for identification of clinical high-risk (CHR), existing predictive models yield low specificity and fail in successfuly predicting transition to psychosis. This, along with the fact that we see a notable decline in transition rates, and the ever-looming lack of resources, means CHR work is still often relegated to research settings. First-episode psychosis (FEP) unit of our institution offers both inpatient and outpatient programs, and while it is common having CHR services emerge from FEP frameworks, there is an inherent risk in drowning the diverse CHR population into very specific FEP interventions and settings, risking additional burden of stigma. Model our institution introduced includes: ⇒Non-dependence on research funding; ⇒Flexible integration in available resources (e.g., FEP interventions, anxiety disorders interventions, substance-use programs); ⇒Dimensional approach with interdisciplinary assessment of capacities/needs non-reliant on supposed diagnosis; ⇒Embedded coordinating clinician ensuring “coordination” of CHR population “dispersed” among different programs; ⇒Collaboration with child psychiatrists allowing smoother transfer of at-risk youth; ⇒Recruitment through sensitized general practitioners and counseling services. No model of care, especially in area lacking conclusive predictive models, can be generalized to different health care systems, as practices and resources vary significantly. Nevertheless, the model presented makes a contribution to the care of CHR population, utilizing/integrating available resources, focusing on dimensional formulation of needs, and avoiding possible stigmatization. Furthermore, widely available CHR services, congruent with any research initiatives, might help us reach the necessary critical mass of data and experience needed for the final push towards clearer prediction models and treatment algorithms.

I will attempt to address the issues surrounding the CHR concept in light of novel data and briefly discuss emerging alternatives. The root problem of the CHR early invention strategy is the exertion of reducing early nonspecific (pluripotent) psychopathology to a unidimensional model restricted only to positive psychotic symptoms, which define the binary categories of CHR and “transition” in help-seeking populations. This major conceptual handicap undermines the validity and clinical utility. The core predictor of the “transition” rate is the degree of the risk-enrichment and not the CHR status. Even with a significant pretest risk enrichment, the prognostic accuracy is mediocre. The incidence and “transition” rates of CHR in the community are very low; therefore, CHR does not represent a cost-effective clinical target—prevention paradox. CHR succeeding early pluripotent psychopathology is already late for intervention. “Transition” is not a categorical progression but a unidimensional shift in psychotic symptoms, and therefore, influenced by the fluctuation of psychotic symptoms, leading to both false positives and underestimation of nonpsychotic psychopathology. There exists no evidence for a specific effect of any intervention in preventing “transition”; therefore, CHR is not an ideal treatment target. Binary “transition” outcome does not represent a valid phenotype for research as “transition” rates are primarily driven by the sampling heterogeneity. The multidimensional psychopathology and functioning are more clinically relevant, overarching, and service-user-centered measures to define individual risk and outcome. Guided by the public health perspective, a universal early intervention framework, underscoring improved access to care, may represent a better strategy.

AbstractBackground.Sex differences in cognitive functioning have long been recognized in schizophrenia patients and healthy controls (HC). However, few studies have focused on patients with an at-risk mental state (ARMS) for psychosis. Thus, the aim of the present study was to investigate sex differences in neurocognitive performance in ARMS patients compared with HC.Methods.The data analyzed in this study were collected within the multicenter European Gene–Environment Interactions study (11 centers). A total of 343 ARMS patients (158 women) and 67 HC subjects (33 women) were included. All participants completed a comprehensive neurocognitive battery. Linear mixed effects models were used to explore whether sex differences in cognitive functioning were present in the total group (main effect of sex) and whether sex differences were different for HC and ARMS (interaction between sex and group).Results.Women performed better in social cognition, speed of processing, and verbal learning than men regardless of whether they were ARMS or HC. However, only differences in speed of processing and verbal learning remained significant after correction for multiple testing. Additionally, ARMS patients displayed alterations in attention, current IQ, speed of processing, verbal learning, and working memory compared with HC.Conclusions.Findings indicate that sex differences in cognitive functioning in ARMS are similar to those seen between healthy men and women. Thus, it appears that sex differences in cognitive performance may not be specific for ARMS, a finding resembling that in patients with schizophrenic psychoses.

Background. Sex differences in cognitive functioning have long been recognized in schizophrenia patients and healthy controls (HC). However, few studies have focused on patients with an at-risk mental state (ARMS) for psychosis. Thus, the aim of the present study was to investigate sex differences in neurocognitive performance in ARMS patients compared with HC. Methods. The data analyzed in this study were collected within the multicenter European Gene-Environment Interactions study (11 centers). A total of 343 ARMS patients (158 women) and 67 HC subjects (33 women) were included. All participants completed a comprehensive neurocognitive battery. Linear mixed effects models were used to explore whether sex differences in cognitive functioning were present in the total group (main effect of sex) and whether sex differences were different for HC and ARMS (interaction between sex and group). Results. Women performed better in social cognition, speed of processing, and verbal learning than men regardless of whether they were ARMS or HC. However, only differences in speed of processing and verbal learning remained significant after correction for multiple testing. Additionally, ARMS patients displayed alterations in attention, current IQ, speed of processing, verbal learning, and working memory compared with HC. Conclusions. Findings indicate that sex differences in cognitive functioning inARMSare similar to those seen between healthy men and women. Thus, it appears that sex differences in cognitive performance may not be specific for ARMS, a finding resembling that in patients with schizophrenic psychoses. [ABSTRACT FROM AUTHOR]

Background Several sex differences in schizophrenia have been reported including differences in cognitive functioning. Studies with schizophrenia patients and healthy controls (HC) indicate that the sex advantage for women in verbal domains is also present in schizophrenia patients. However, findings have been inconsistent. No study focused on sex-related cognitive performance differences in at-risk mental state for psychosis (ARMS) individuals yet. Thus, the aim of the present study was to investigate sex differences in cognitive functioning in ARMS, first episode psychosis (FEP) and HC subjects. We expected a better verbal learning and memory performance of women in all groups. Methods The neuropsychological data analysed in this study were collected within the prospective F rüh e rkennung von Psy chosen (FePsy) study. In total, 118 ARMS, 88 FEP individuals and 86 HC completed a cognitive test battery covering the domains of executive functions, attention, working memory, verbal learning and memory, IQ and speed of processing. Results Women performed better in verbal learning and memory regardless of diagnostic group. By contrast, men as compared to women showed a shorter reaction time during the working memory task across all groups. Conclusion The results provide evidence that women generally perform better in verbal learning and memory, independent of diagnostic group (ARMS, FEP, HC). The finding of a shorter reaction time for men in the working memory task could indicate that men have a superior working memory performance since they responded faster during the target trials, while maintaining a comparable overall working memory performance level. [ABSTRACT FROM AUTHOR]

Prodromal symptoms may precede onset of the psychotic disorders by years, and while we have instruments for identification of clinical high-risk (CHR), existing predictive models yield low specificity and fail in successfuly predicting transition to psychosis. This, along with the fact that we see a notable decline in transition rates, and the everlooming lack of resources, means CHR work is still often relegated to research settings. First-episode psychosis (FEP) unit of our institution offers both inpatient and outpatient programs, and while it is common having CHR services emerge from FEP frameworks, there is an inherent risk in drowning the diverse CHR population into very specific FEP interventions and settings, risking additional burden of stigma. Model our institution introduced includes:)Nondependence on research funding; Flexible integration in available resources (e.g., FEP interventions, anxiety disorders interventions, substance-use programs); Dimensional approach with interdisciplinary assessment of capacities/needs non-reliant on supposed diagnosis;)Embedded coordinating clinician ensuring "coordination" of CHR population "dispersed" among different programs;)Collaboration with child psychiatrists allowing smoother transfer of at-risk youth; Recruitment through sensitized general practitioners and counseling services. No model of care, especially in area lacking conclusive predictive models, can be generalized to different health care systems, as practices and resources vary significantly. Nevertheless, the model presented makes a contribution to the care of CHRpopulation, utilizing/integrating available resources, focusing on dimensional formulation of needs, and avoiding possible stigmatization. Furthermore, widely availableCHR services, congruent with any research initiatives, might help us reach the necessary critical mass of data and experience needed for the final push towards clearer prediction models and treatment algorithms. [ABSTRACT FROM AUTHOR]

I will attempt to address the issues surrounding the CHR concept in light of novel data and briefly discuss emerging alternatives. The root problem of the CHR early invention strategy is the exertion of reducing early nonspecific (pluripotent) psychopathology to a unidimensional model restricted only to positive psychotic symptoms, which define the binary categories of CHR and "transition" in helpseeking populations. This major conceptual handicap undermines the validity and clinical utility. The core predictor of the "transition" rate is the degree of the risk-enrichment and not the CHR status. Even with a significant pretest risk enrichment, the prognostic accuracy is mediocre. The incidence and "transition" rates of CHR in the community are very low; therefore, CHR does not represent a cost-effective clinical target--prevention paradox. CHR succeeding early pluripotent psychopathology is already late for intervention. "Transition" is not a categorical progression but a unidimensional shift in psychotic symptoms, and therefore, influenced by the fluctuation of psychotic symptoms, leading to both false positives and underestimation of nonpsychotic psychopathology. There exists no evidence for a specific effect of any intervention in preventing "transition"; therefore, CHR is not an ideal treatment target. Binary "transition" outcome does not represent a valid phenotype for research as "transition" rates are primarily driven by the sampling heterogeneity. The multidimensional psychopathology and functioning are more clinically relevant, overarching, and service-user-centered measures to define individual risk and outcome. Guided by the public health perspective, a universal early intervention framework, underscoring improved access to care, may represent a better strategy. [ABSTRACT FROM AUTHOR]