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5. Insulin resistance and obesity, and their association with depression in relatively young people: findings from a large UK birth cohort

Author

Perry, B. I., Khandaker, G. M., Marwaha, S., Thompson, Andrew D., Zammit, S., Singh, Swaran P., Upthegrove, R., Perry, BI [0000-0002-1533-026X], and Apollo - University of Cambridge Repository

Subjects
Inflammation, Male, Depressive Disorder, obesity, Pediatric Obesity, Adolescent, Depression, Interleukin-6, Original Articles, Comorbidity, ALSPAC, United Kingdom, Body Mass Index, C-Reactive Protein, Cross-Sectional Studies, insulin resistance, Glucose Intolerance, overweight, Humans, Female, Longitudinal Studies, Child, RC, Glucose Metabolism Disorders
Abstract

Background\ud \ud Depression frequently co-occurs with disorders of glucose and insulin homeostasis (DGIH) and obesity. Low-grade systemic inflammation and lifestyle factors in childhood may predispose to DGIH, obesity and depression. We aim to investigate the cross-sectional and longitudinal associations among DGIH, obesity and depression, and to examine the effect of demographics, lifestyle factors and antecedent low-grade inflammation on such associations in young people.\ud \ud Methods\ud \ud Using the Avon Longitudinal Study of Parents and Children birth cohort, we used regression analyses to examine: (1) cross-sectional and (2) longitudinal associations between measures of DGIH [insulin resistance (IR); impaired glucose tolerance] and body mass index (BMI) at ages 9 and 18 years, and depression (depressive symptoms and depressive episode) at age 18 years and (3) whether sociodemographics, lifestyle factors or inflammation [interleukin-6 (IL-6) at age 9 years] confounded any such associations.\ud \ud Results\ud \ud We included 3208 participants. At age 18 years, IR and BMI were positively associated with depression. These associations may be explained by sociodemographic and lifestyle factors. There were no longitudinal associations between DGIH/BMI and depression, and adjustment for IL-6 and C-reactive protein did not attenuate associations between IR/BMI and depression; however, the longitudinal analyses may have been underpowered.\ud \ud Conclusions\ud \ud Young people with depression show evidence of DGIH and raised BMI, which may be related to sociodemographic and lifestyle effects such as deprivation, smoking, ethnicity and gender. In future, studies with larger samples are required to confirm this. Preventative strategies for the poorer physical health outcomes associated with depression should focus on malleable lifestyle factors.

Published
2019

7. Associations between maternal prenatal C-reactive protein and risk factors for psychosis in adolescent offspring:findings from the Northern Finland Birth Cohort 1986

Author

Ramsay, H. (Hugh), Surcel, H.-M. (Heljä-Marja), Björnholm, L. (Lassi), Kerkelä, M. (Martta), Khandaker, G. M. (Golam M.), Veijola, J. (Juha), Ramsay, H. (Hugh), Surcel, H.-M. (Heljä-Marja), Björnholm, L. (Lassi), Kerkelä, M. (Martta), Khandaker, G. M. (Golam M.), and Veijola, J. (Juha)

Abstract

Prenatal infection is associated with brain structural and functional abnormalities and may increase the risk for psychosis through a direct effect on neurodevelopment. Various infections may exert their effect through a proinflammatory immune response but studies of prenatal maternal inflammatory markers and offspring neurodevelopment are scarce. Using the longitudinal Northern Finland Birth Cohort 1986 study, we examined the associations of maternal prenatal C-reactive protein (CRP) levels with psychosis risk factors in adolescent offspring. CRP was measured in maternal sera collected in pregnancy. In offspring, school performance was measured at age 7 years, while school performance, psychotic experiences, and cannabis use were measured at age 16 years. We tested associations of CRP with offspring measures using regression analysis controlling for offspring sex, maternal education level, and prenatal maternal body mass index, smoking and alcohol use in pregnancy, place of birth, maternal psychiatric admission, paternal psychiatric admission, mothers age at birth, and gestational week of CRP sample. We also tested if adolescent cannabis use mediated the associations between maternal CRP and offspring outcomes. Controlling for covariates, maternal CRP was associated with academic performance at age 16 years (beta = .062, 95% CI = 0.036–0.088), but not with possible psychotic experiences at 16 years (odds ratio [OR] = 1.09, 95% CI = 0.96–1.24). Maternal CRP was also associated with adolescent cannabis use (OR = 1.24, 95% CI = 1.07–1.43). These findings suggest that prenatal inflammation may influence later mental illness risk by affecting neurodevelopment and also indirectly by increasing the risk of exposure to cannabis.

Published
2021

13. Association between developmental milestones and age of schizophrenia onset:results from the Northern Finland Birth Cohort 1966

Author

Stochl, J. (Jan), Whittier, A. (Anjalene), Wagner, A. P. (Adam P.), Veijola, J. (Juha), Jääskeläinen, E. (Erika), Miettunen, J. (Jouko), Khandaker, G. M. (Golam M.), and Jones, P. B. (Peter B.)

Subjects
schizophrenia, non-affective psychoses, age at onset, developmental milestones
Abstract

We investigated relationships between early developmental milestones, schizophrenia incidence and variability in its age at onset. We hypothesized that the period of risk for schizophrenia would be longer for those with later development. The Northern Finland Birth Cohort 1966 was followed until 47 years of age, and those members diagnosed with schizophrenia or any other non-affective psychoses identified. Latent profile analysis was used to classify people into homogenous classes with respect to developmental milestones, and subsequently survival analysis explored relationship between classes and age of schizophrenia onset. Results suggest that 4-classes (early, regular, late, and extra late developers) can be identified, but due to few cases in one class (n = 93

Published
2019

14. Association between childhood infection, serum inflammatory markers and intelligence:findings from a population-based prospective birth cohort study

Author

MACKINNON, N., ZAMMIT, S., LEWIS, G., JONES, P. B., and KHANDAKER, G. M.

Subjects
Birth cohort study, interleukin 6, intelligence quotient, inflammatory markers, infection, C-reactive protein
Abstract

A link between infection, inflammation, neurodevelopment and adult illnesses has been proposed. The objective of this study was to examine the association between infection burden during childhood – a critical period of development for the immune and nervous systems – and subsequent systemic inflammatory markers and general intelligence. In the Avon Longitudinal Study of Parents and Children, a prospective birth cohort in England, we examined the association of exposure to infections during childhood, assessed at seven follow-ups between age 1·5 and 7·5 years, with subsequent: (1) serum interleukin 6 and C-reactive protein (CRP) levels at age 9; (2) intelligence quotient (IQ) at age 8. We also examined the relationship between inflammatory markers and IQ. Very high infection burden (90+ percentile) was associated with higher CRP levels, but this relationship was explained by body mass index (adjusted odds ratio (OR) 1·19; 95% confidence interval (CI) 0·95–1·50), maternal occupation (adjusted OR 1·23; 95% CI 0·98–1·55) and atopic disorders (adjusted OR 1·24; 95% CI 0·98–1·55). Higher CRP levels were associated with lower IQ; adjusted β = −0·79 (95% CI −1·31 to −0·27); P = 0·003. There was no strong evidence for an association between infection and IQ. The findings indicate that childhood infections do not have an independent, lasting effect on circulating inflammatory marker levels subsequently in childhood; however, elevated inflammatory markers may be harmful for intellectual development/function.

Published
2017

15. Early motor developmental milestones and schizotypy in the Northern Finland Birth Cohort Study 1966

Author

Filatova, S. (Svetlana), Koivumaa-Honkanen, H. (Heli), Khandaker, G. M. (Golam M.), Lowry, E. (Estelle), Nordström, T. (Tanja), Hurtig, T. (Tuula), Moilanen, K. (Kristiina), Miettunen, J. (Jouko), Filatova, S. (Svetlana), Koivumaa-Honkanen, H. (Heli), Khandaker, G. M. (Golam M.), Lowry, E. (Estelle), Nordström, T. (Tanja), Hurtig, T. (Tuula), Moilanen, K. (Kristiina), and Miettunen, J. (Jouko)

Abstract

Delayed motor developmental milestones have been reported to be associated with schizophrenia in previous studies, but no study has examined the relationship between early motor developmental milestones and schizotypy. We have examined this relationship in a prospective birth cohort. In the Northern Finland Birth Cohort 1966, data on 9 early motor developmental milestones were collected prospectively from visits to child welfare centers, and data on adult schizotypy were collected through a questionnaire (N = 4557–4674). Positive schizotypy was measured by the Perceptual Aberration Scale (PAS), negative schizotypy was measured by Physical Anhedonia Scale (PhAS) and Social Anhedonia Scale (SAS). Three related scales were included: Schizoidia Scale (SCHD), Hypomanic Personality Scale (HPS), and Bipolar II Scale (BIP2). We examined the milestone–schizotypy associations before and after excluding cases of schizophrenia from this population-based sample. Hierarchical regression analyses adjusted for covariates and separately for both genders were performed. In men, each extra month of delay in achievement of touching thumb with index finger, sitting unsupported, standing up, walking with support, or walking unsupported was associated with an increase in PAS, PhAS, or SCHD scores, or decrease in BIP2 score (P < 0.05). In women, each extra month of delay in achievement of turning from back to tummy was associated with an increase in PhAS and SAS scores (P < 0.05). Schizotypy is associated with delayed motor developmental milestones in early-life, but there is some heterogeneity with regards to types of milestones and gender. These findings suggest delayed motor development confers risk across the continuum of schizophrenia syndrome.

Published
2018

16. Insulin resistance and obesity, and their association with depression in relatively young people: findings from a large UK birth cohort.

Author

Perry, B. I., Khandaker, G. M., Marwaha, S., Thompson, A., Zammit, S., Singh, S. P., and Upthegrove, R.

Subjects
*C-reactive protein, *MENTAL depression, *ETHNIC groups, *INFLAMMATION, *INTERLEUKINS, *LONGITUDINAL method, *OBESITY, *POVERTY, *REGRESSION analysis, *RISK assessment, *SEX distribution, *SMOKING, *SOCIOECONOMIC factors, *BODY mass index, *LIFESTYLES, *CROSS-sectional method, *GLUCOSE intolerance, *DISEASE risk factors, INSULIN resistance risk factors
Abstract

Background: Depression frequently co-occurs with disorders of glucose and insulin homeostasis (DGIH) and obesity. Low-grade systemic inflammation and lifestyle factors in childhood may predispose to DGIH, obesity and depression. We aim to investigate the cross-sectional and longitudinal associations among DGIH, obesity and depression, and to examine the effect of demographics, lifestyle factors and antecedent low-grade inflammation on such associations in young people. Methods: Using the Avon Longitudinal Study of Parents and Children birth cohort, we used regression analyses to examine: (1) cross-sectional and (2) longitudinal associations between measures of DGIH [insulin resistance (IR); impaired glucose tolerance] and body mass index (BMI) at ages 9 and 18 years, and depression (depressive symptoms and depressive episode) at age 18 years and (3) whether sociodemographics, lifestyle factors or inflammation [interleukin-6 (IL-6) at age 9 years] confounded any such associations. Results: We included 3208 participants. At age 18 years, IR and BMI were positively associated with depression. These associations may be explained by sociodemographic and lifestyle factors. There were no longitudinal associations between DGIH/BMI and depression, and adjustment for IL-6 and C-reactive protein did not attenuate associations between IR/BMI and depression; however, the longitudinal analyses may have been underpowered. Conclusions: Young people with depression show evidence of DGIH and raised BMI, which may be related to sociodemographic and lifestyle effects such as deprivation, smoking, ethnicity and gender. In future, studies with larger samples are required to confirm this. Preventative strategies for the poorer physical health outcomes associated with depression should focus on malleable lifestyle factors. [ABSTRACT FROM AUTHOR]

Published
2020
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18. Serum C-reactive protein in adolescence and risk of schizophrenia in adulthood:a prospective birth cohort study

Author

Metcalf, S. A. (Stephen A.), Jones, P. B. (Peter B.), Nordström, T. (Tanja), Timonen, M. (Markku), Mäki, P. (Pirjo), Miettunen, J. (Jouko), Jääskeläinen, E. (Erika), Järvelin, M.-R. (Marjo-Riitta), Stochl, J. (Jan), Murray, G. K. (Graham K.), Veijola, J. (Juha), Khandaker, G. M. (Golam M.), Metcalf, S. A. (Stephen A.), Jones, P. B. (Peter B.), Nordström, T. (Tanja), Timonen, M. (Markku), Mäki, P. (Pirjo), Miettunen, J. (Jouko), Jääskeläinen, E. (Erika), Järvelin, M.-R. (Marjo-Riitta), Stochl, J. (Jan), Murray, G. K. (Graham K.), Veijola, J. (Juha), and Khandaker, G. M. (Golam M.)

Abstract

Objective: Meta-analyses of cross-sectional studies confirm an increase in circulating inflammatory markers during acute psychosis. Longitudinal studies are scarce but are needed to understand whether elevated inflammatory markers are a cause or consequence of illness. We report a longitudinal study of serum C-reactive protein (CRP) in adolescence and subsequent risk of schizophrenia and related psychoses in adulthood in the Northern Finland Birth Cohort 1986. Method: Serum high-sensitivity CRP was measured at age 15/16 years in 6362 participants. ICD-10 diagnoses of schizophrenia and related psychoses were obtained from centralised hospital inpatient and outpatient registers up to age 27 years. Logistic regression calculated odds ratios (ORs) for psychotic outcomes associated with baseline CRP levels analysed as both continuous and categorical variables using American Heart Association criteria. Age, sex, body mass index, maternal education, smoking, and alcohol use were included as potential confounders. Results: By age 27 years, 88 cases of non-affective psychosis (1.38%), of which 22 were schizophrenia (0.35%), were identified. Adolescent CRP was associated with subsequent schizophrenia. The adjusted OR for schizophrenia by age 27 years for each standard deviation (SD) increase in CRP levels at age 15/16 years was 1.25 (95% CI, 1.07–1.46), which was consistent with a linear, dose-response relationship (P-value for quadratic term 0.23). Using CRP as a categorical variable, those with high (>3 mg/L) compared with low (<1 mg/L) CRP levels at baseline were more likely to develop schizophrenia; adjusted OR 4.25 (95% CI, 1.30–13.93). There was some indication that higher CRP was associated with earlier onset of schizophrenia (rs = −0.40; P = 0.07). Conclusions: A longitudinal association between adolescent CRP levels and adult schizophrenia diagnosis indicates a potentially important role of inflammation in the pathogenesis of the illness, although the

Published
2017

22. A comparison of the cumulative incidence and early risk factors for psychotic disorder in young adults in the Northern Finland Birth Cohorts 1966 and 1986

Author

Filatova, S., primary, Marttila, R., additional, Koivumaa-Honkanen, H., additional, Nordström, T., additional, Veijola, J., additional, Mäki, P., additional, Khandaker, G. M., additional, Isohanni, M., additional, Jääskeläinen, E., additional, Moilanen, K., additional, and Miettunen, J., additional

Published
2016
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23. Childhood inflammatory markers and intelligence as predictors of subsequent persistent depressive symptoms: a longitudinal cohort study.

Author

Khandaker, G. M., Stochl, J., Zammit, S., Goodyer, I., Lewis, G., and Jones, P. B.

Subjects
*BRAIN physiology, *DIAGNOSIS of mental depression, *AGE factors in disease, *BIOMARKERS, *C-reactive protein, *CONFIDENCE intervals, *DOSE-response relationship in biochemistry, *INFLAMMATION, *INTELLECT, *INTERLEUKINS, *LATENT structure analysis, *LONGITUDINAL method, *QUESTIONNAIRES, *SEVERITY of illness index, *ODDS ratio, *CHILDREN
Abstract

Background: To identify developmental sub-groups of depressive symptoms during the second decade of life, a critical period of brain development, using data from a prospective birth cohort. To test whether childhood intelligence and inflammatory markers are associated with subsequent persistent depressive symptoms. Methods: IQ, a proxy for neurodevelopment, was measured at age 8 years. Interleukin 6 (IL-6) and C-reactive protein, typical inflammatory markers, were measured at age 9 years. Depressive symptoms were measured six times between 10 and 19 years using the short mood and feelings questionnaire (SMFQ), which were coded as binary variable and then used in latent class analysis to identify developmental sub-groups of depressive symptoms. Results: Longitudinal SMFQ data from 9156 participants yielded three distinct population sub-groups of depressive symptoms: no symptoms (81.2%); adolescent-onset symptoms (13.2%); persistent symptoms (5.6%). Lower IQ and higher IL-6 levels in childhood were independently associated with subsequent persistent depressive symptoms in a linear, dose–response fashion, but not with adolescent-onset symptoms. Compared with the group with no symptoms the adjusted odds ratio for persistent depressive symptoms per s.d. increase in IQ was 0.80 (95% CI, 0.68–0.95); that for IL-6 was 1.20 (95% CI, 1.03–1.39). Evidence for an association with IL-6 remained after controlling for initial severity of depressive symptoms at 10 years. There was no evidence that IL-6 moderated or mediated the IQ-persistent depressive symptom relationship. Conclusions: The results indicate potentially important roles for two distinct biological processes, neurodevelopment and inflammation, in the aetiology of persistent depressive symptoms in young people. [ABSTRACT FROM AUTHOR]

Published
2018
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26. Antidepressant activity of anti-cytokine treatment: a systematic review and meta-analysis of clinical trials of chronic inflammatory conditions

Author

Kappelmann, N, Lewis, G, Dantzer, R, Jones, P B, and Khandaker, G M

Abstract

Inflammatory cytokines are commonly elevated in acute depression and are associated with resistance to monoaminergic treatment. To examine the potential role of cytokines in the pathogenesis and treatment of depression, we carried out a systematic review and meta-analysis of antidepressant activity of anti-cytokine treatment using clinical trials of chronic inflammatory conditions where depressive symptoms were measured as a secondary outcome. Systematic search of the PubMed, EMBASE, PsycINFO and Cochrane databases, search of reference lists and conference abstracts, followed by study selection process yielded 20 clinical trials. Random effect meta-analysis of seven randomised controlled trials (RCTs) involving 2370 participants showed a significant antidepressant effect of anti-cytokine treatment compared with placebo (standardised mean difference (SMD)=0.40, 95% confidence interval (CI), 0.22–0.59). Anti-tumour necrosis factor drugs were most commonly studied (five RCTs); SMD=0.33 (95% CI; 0.06–0.60). Separate meta-analyses of two RCTs of adjunctive treatment with anti-cytokine therapy and eight non-randomised and/or non-placebo studies yielded similar small-to-medium effect estimates favouring anti-cytokine therapy; SMD=0.19 (95% CI, 0.00–0.37) and 0.51 (95% CI, 0.34–0.67), respectively. Adalimumab, etanercept, infliximab and tocilizumab all showed statistically significant improvements in depressive symptoms. Meta-regression exploring predictors of response found that the antidepressant effect was associated with baseline symptom severity (P=0.018) but not with improvement in primary physical illness, sex, age or study duration. The findings indicate a potentially causal role for cytokines in depression and that cytokine modulators may be novel drugs for depression in chronically inflamed subjects. The field now requires RCTs of cytokine modulators using depression as the primary outcome in subjects with high inflammation who are free of other physical illnesses.

Published
2018
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30. Childhood immuno-metabolic markers and risk of depression and psychosis in adulthood: A prospective birth cohort study.

Author

Donnelly NA, Perry BI, Jones HJ, and Khandaker GM

Subjects
Adult, Birth Cohort, Child, Cohort Studies, Female, Humans, Male, Prospective Studies, Young Adult, Depression, Psychotic Disorders
Abstract

Background: Metabolic and inflammatory disorders commonly co-occur with depression and psychosis, with emerging evidence implicating immuno-metabolic dysfunction in their aetiology. Previous studies have reported metabolic dysfunction and inflammation in adults with depression and psychosis. However, longitudinal studies testing the direction of association, and the effects of different dimensions of early-life immuno-metabolic dysfunction on adult psychopathology are limited., Methods: Using data from 3258 birth cohort participants we examined longitudinal associations of three metabolic hormones (leptin, adiponectin, insulin) at age 9 with risks for depression- and psychosis-spectrum outcomes at age 24. In addition, using nine immuno-metabolic biomarkers (leptin, adiponectin, insulin, interleukin-6, C-Reactive protein, low density lipoprotein, high density lipoprotein, triglycerides, and BMI), we constructed an exploratory bifactor model showing a general immuno-metabolic factor and three specific factors (adiposity, inflammation, and insulin resistance), which were also used as exposures., Results: Childhood leptin was associated with adult depressive episode (adjusted odds ratio (aOR)= 1.31; 95% CI, 1.02-1.71) and negative symptoms (aOR=1.15; 95% CI, 1.07-1.24), but not positive psychotic symptoms. The general immuno-metabolic factor was associated with atypical depressive symptoms (aOR=1.07; 95% CI, 1.01-1.14) and psychotic experiences (aOR=1.21; 95% CI, 1.02-1.44). The adiposity factor was associated with negative symptoms (aOR=1.07; 95% CI 1.02-1.12). Point estimates tended to be larger in women, though 95% credible intervals overlapped with those for men. In women, the inflammatory factor was associated with depressive episodes (aOR=1.27; 95% CI, 1.03-1.57)., Conclusions: While general immuno-metabolic dysfunction in childhood may contribute to risks for both psychotic and depressive symptoms in adulthood, childhood adiposity and inflammation appear to be particularly linked to affective (depressive and negative), but not positive psychotic symptoms., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Published
2022
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31. Identifying key targets for interventions to improve psychological wellbeing: replicable results from four UK cohorts.

Author

Stochl J, Soneson E, Wagner AP, Khandaker GM, Goodyer I, and Jones PB

Subjects
Adolescent, Cohort Studies, Female, Health Surveys, Humans, Male, Sex Factors, United Kingdom, Young Adult, Mental Health, Personal Satisfaction, Psychometrics methods, Quality of Life psychology
Abstract

Background: An increasing importance is being placed on mental health and wellbeing at individual and population levels. While there are several interventions that have been proposed to improve wellbeing, more evidence is needed to understand which aspects of wellbeing are most influential. This study aimed to identify key items that signal improvement of mental health and wellbeing., Methods: Using network analysis, we identified the most central items in the graph network estimated from the well-established Warwick-Edinburgh Mental Well-being Scale (WEMWBS). Results were compared across four major UK cohorts comprising a total of 47,578 individuals: the Neuroscience in Psychiatry Network, the Scottish Schools Adolescent Lifestyle and Substance Use Survey, the Northern Ireland Health Survey, and the National Child Development Study., Results: Regardless of gender, the three items most central in the network were related to positive self-perception and mood: 'I have been feeling good about myself'; 'I have been feeling confident'; and 'I have been feeling cheerful'. Results were consistent across all four cohorts., Conclusions: Positive self-perception and positive mood are central to psychological wellbeing. Psychotherapeutic and public mental health interventions might best promote psychological wellbeing by prioritising the improvement of self-esteem, self-confidence and cheerfulness. However, empirical testing of interventions using these key targets is needed.

Published
2019
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32. Early motor developmental milestones and schizophrenia: A systematic review and meta-analysis.

Author

Filatova S, Koivumaa-Honkanen H, Hirvonen N, Freeman A, Ivandic I, Hurtig T, Khandaker GM, Jones PB, Moilanen K, and Miettunen J

Subjects
Adolescent, Child, Child Development, Child, Preschool, Developmental Disabilities complications, Developmental Disabilities physiopathology, Humans, Infant, Infant, Newborn, Schizophrenia complications, Motor Skills, Schizophrenia physiopathology
Abstract

The neurodevelopmental hypothesis of schizophrenia proposes that impaired brain development is a cause of the illness. Early motor developmental milestones, such as learning to walk, are predictors of later schizophrenia but studies have not been systematically reviewed. The aim of the present systematic review and meta-analysis was to explore the association between early motor developmental milestones and the risk of adult schizophrenia. In addition, we updated a systematic review on motor function and risk of schizophrenia. The PubMed, PsycINFO and Scopus databases were searched for original research articles published up to July 2015. Motor milestones were measured between ages 0 and 13years. Random effect meta-analysis calculated effect estimates (Hedges' g) for the association between individual motor milestones and schizophrenia risk. An electronic database and selected articles reference list search identified 5990 articles after removing duplicates. Sixty-nine full text articles were assessed for eligibility of which six were included in the review. Five studies provided sufficient data for meta-analyses. The following motor milestones were significantly associated with adult schizophrenia risk: walking unsupported (g=0.46; 95% CI 0.27-0.64; p<0.001), standing unsupported (g=0.28; 0.16-0.40; p<0.001) and sitting unsupported (g=0.18; 0.05-0.31; p=0.007). Results for the milestones 'holding head up' and 'grabbing object' were not statistically significant. Delayed walking, sitting and standing unsupported were associated with adult onset schizophrenia. The findings emphasise the importance of timely achievement of these motor milestones in childhood and can contribute to the identification of individuals at risk of psychosis., (Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.)

Published
2017
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