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Dialogues in Clinical Neuroscience 2005Screening for preschizophrenia in the general population with the aim of preventing transition to full-blown illness is an epidemiological impossibility because a rare... (Review)
Review
Screening for preschizophrenia in the general population with the aim of preventing transition to full-blown illness is an epidemiological impossibility because a rare disease cannot be predicted. The lack of specificity resulting in abundance of false-positives can be remedied in part by using much more restrictive screening criteria that combine several indicators of risk for transition to schizophrenia. Raising the specificity (reducing the false-positives), however, can only be done at the expense of sensitivity (increasing the false-negatives). The most commonly used strategy to raise specificity is the sample enrichment strategy. This involves the creation of samples enriched with schizophrenia risk by selectively filtering at-risk people out over a range of consecutive referral processes starting in the general population, through to general practioners, mental health services, and the early detection clinic. However, improvements in specificity obtained by the sample enrichment strategy should not be attributed to the use of some predictive instrument that supposedly identifies high-risk individuals. The epidemiologically and ethically most viable way for screening and early detection is to selectively increase the permeability of the filters on the pathway to mental health care. This will occasion samples of help-seekers enriched with schizophrenia risk at the level of mental health services (thus reducing false-positives), while at the same time making an attempt to "attract" as many detectable schizophrenia prodromes as possible through the filters along the pathway to mental health care (thus reducing false-negatives). Early psychosis research has yielded some useful suggestions in that it is becoming increasingly clear that it is not just psychosis itself, but rather the clinical context of the psychotic experience that determines risk for transition to schizophrenia. Thus, risk for transition to full-blown psychotic disorder is to a large degree determined by size of psychosis "load," comorbid distress and depression, cannabis use, cognitive ability, and subjective reports of impairment and coping. Making a diagnosis of psychotic disorder is not an exact science: it involves an arbitrary cutoff imposed on dimensional variation of psychopathology and need for care over time. Gaining insight into the cognitive and biological factors that drive the dimensional variation, including therapeutic interventions, is arguably more useful than sterile dichotomous prediction models.
Topics: Global Health; Humans; Psychotic Disorders; Risk Factors; Schizophrenia
PubMed: 16060596
DOI: 10.31887/DCNS.2005.7.1/jvanos -
PloS One 2021A high prevalence of metabolic syndrome and its components in patients with psychotic disorders may increase the risk for cardiovascular diseases. Unfortunately,... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
A high prevalence of metabolic syndrome and its components in patients with psychotic disorders may increase the risk for cardiovascular diseases. Unfortunately, relatively little work in this field has emerged from low-resourced contexts. This study investigated the prevalence, correlates, and treatment patterns of metabolic disorders in patients with psychotic disorders in Western Kenya.
METHODS
300 patients with psychosis and 300 controls were recruited at Moi Teaching and Referral Hospital in Eldoret, Kenya. Data on demographic characteristics, weight, height, abdominal circumference, blood pressure, blood glucose, lipid profile, and treatments were collected. Categorical and continuous data were compared between the patient and control groups using Pearson's chi-squared tests and t-tests, respectively. Variables found to be significantly different between these groups were included in logistic regression models to determine potential predictors of metabolic syndrome.
RESULTS
Compared to controls, patients with psychosis were found to have a higher mean random blood glucose [5.23 vs 4.79, p = 0.003], higher body mass index [5.23 vs 4.79, p = 0.001], higher triglycerides [1.98 vs 1.56, p<0.001], larger waist circumference [89.23 vs 86.39, p = 0.009] and lower high density lipoprotein [1.22 vs 1.32, p<0.001]. The odds of developing metabolic syndrome were increased with age [OR = 1.05, CI: 1.02-1.07] and presence of a psychotic disorder [OR = 2.09 [CI 1.23-3.55]; and were reduced with female gender [OR 0.41, CI 0.25-0.67], among those who were never married [OR 0.52, CI 0.28-0.94] and among the widowed/separated/ divorced marital status [OR 0.38, CI 0.17-0.81]. While the majority of patients received treatment with olanzapine, there was no association between olanzapine use and metabolic syndrome and its components. More than half of the patients in this study sample were not receiving treatment for the various components of metabolic syndrome.
CONCLUSION
In the study setting of Eldoret, metabolic syndrome and its components were more prevalent among patients with psychotic disorders than in controls; and a clear treatment gap for these disorders was evident. There is a need for efforts to ensure adequate screening and treatment for these physical disorders in resource-limited settings.
Topics: Adolescent; Adult; Aged; Female; Humans; Kenya; Male; Metabolic Syndrome; Middle Aged; Prevalence; Psychotic Disorders
PubMed: 33428652
DOI: 10.1371/journal.pone.0245086 -
Tijdschrift Voor Psychiatrie 2016Persons with a psychotic disorder commonly experience difficulties with what is considered to be metacognitive capacity. In this article we discuss several definitions... (Review)
Review
BACKGROUND
Persons with a psychotic disorder commonly experience difficulties with what is considered to be metacognitive capacity. In this article we discuss several definitions of this concept, the measurement instruments involved and the clinical interventions that target this concept.
AIM
To present a review of various frequently used definitions of metacognition and related concepts and to describe the measurement instruments involved and the treatment options available for improving the metacognitive capacity of persons with a psychotic disorder.
METHOD
We present an overview of several definitions of metacognition in psychotic disorders and we discuss frequently used measurement instruments and treatment options. The article focuses on recent developments in a model devised by Semerari et al. The measurement instrument involved (Metacognition Assessment Scale - A) is discussed in terms of it being an addition to existing methods.
RESULTS
On the basis of the literature it appears that metacognition and related concepts are measurable constructs, although definitions and instruments vary considerably. The new conceptualisation of social information processing also leads to the development of a new form of psychotherapy that aims to help patients suffering from psychotic disorders to improve metacognitive capacity.
CONCLUSION
There seems to be evidence that metacognitive abilities are a possible target for treatment, but further research is needed.
Topics: Cognition Disorders; Humans; Metacognition; Psychotherapy; Psychotic Disorders; Schizophrenia; Schizophrenic Psychology; Theory of Mind
PubMed: 27320509
DOI: No ID Found -
PloS One 2013S100B is a potential marker of neurological and psychiatric illness. In schizophrenia, increased S100B levels, as well as associations with acute positive and persisting...
BACKGROUND
S100B is a potential marker of neurological and psychiatric illness. In schizophrenia, increased S100B levels, as well as associations with acute positive and persisting negative symptoms, have been reported. It remains unclear whether S100B elevation, which possibly reflects glial dysfunction, is the consequence of disease or compensatory processes, or whether it is an indicator of familial risk.
METHODS
Serum samples were acquired from two large independent family samples (n = 348 and n = 254) in the Netherlands comprising patients with psychotic disorder (n = 140 and n = 82), non-psychotic siblings of patients with psychotic disorder (n = 125 and n = 94) and controls (n = 83 and n = 78). S100B was analyzed with a Liaison automated chemiluminescence system. Associations between familial risk of psychotic disorder and S100B were examined.
RESULTS
Results showed that S100B levels in patients (P) and siblings (S) were not significantly different from controls (C) (dataset 1: P vs. C: B = 0.004, 95% CI -0.005 to 0.013, p = 0.351; S vs. C: B = 0.000, 95% CI -0.009 to 0.008, p = 0.926; and dataset 2: P vs. C: B = 0.008, 95% CI -0.011 to 0.028, p = 0.410; S vs. C: B = 0.002, 95% CI -0.016 to 0.021, p = 0.797). In patients, negative symptoms were positively associated with S100B (B = 0.001, 95% CI 0.000 to 0.002, p = 0.005) in one of the datasets, however with failure of replication in the other. There was no significant association between S100B and positive symptoms or present use or type of antipsychotic medication.
CONCLUSIONS
S100B is neither an intermediate phenotype, nor a trait marker for psychotic illness.
Topics: Adolescent; Adult; Biomarkers; Female; Humans; Male; Middle Aged; Psychotic Disorders; Risk Factors; S100 Calcium Binding Protein beta Subunit; Severity of Illness Index; Young Adult
PubMed: 24358202
DOI: 10.1371/journal.pone.0082535 -
PloS One 2019Although people with a psychotic disorder are approximately four to six times more often victimized than the general population, victimization is not routinely assessed...
INTRODUCTION
Although people with a psychotic disorder are approximately four to six times more often victimized than the general population, victimization is not routinely assessed in mental healthcare. This study investigates prevalence, context and risk factors of victimization in patients with a psychotic disorder in the Northern, relatively rural region of the Netherlands. Moreover, disclosure rates and awareness of psychiatrists are examined.
METHOD
Information on personal crime (threats, assaults and sexual violence), property and other forms of crime, the context of victimization and disclosure was routinely assessed in 353 patients with a psychotic disorder who received care at a mental health facility. In addition, involved psychiatrists reported on last year's victimization incidents in their patients.
RESULTS
One third of the patients reported victimization in the previous year. More than half of the crimes were committed by someone acquainted and took place in the victim's own home or a place familiar to the victim. Younger age, having a comorbid disorder, drug use and perpetration of a crime were all positively associated with victimization. Approximately half of the reported personal crimes were disclosed to a health care professional but only in 16% of the cases the involved psychiatrist report to know about the incident.
CONCLUSION
This study confirms that people with a history of psychosis have an increased risk of becoming the victim of a crime. Although our results suggest that in fifty percent of cases the patients did share the information with professionals, a substantial proportion of incidents appear to go still unnoticed.
Topics: Adult; Crime Victims; Disclosure; Female; Humans; Male; Mandatory Reporting; Middle Aged; Netherlands; Prevalence; Psychotic Disorders; Risk Factors
PubMed: 31318903
DOI: 10.1371/journal.pone.0219056 -
Schizophrenia Research Feb 2019Cognitive dysfunction is common in psychotic disorders, and may reflect underlying pathophysiology. However, substantial cognitive heterogeneity exists both within and...
BACKGROUND
Cognitive dysfunction is common in psychotic disorders, and may reflect underlying pathophysiology. However, substantial cognitive heterogeneity exists both within and between diagnostic categories, creating challenges for studying the neurobiology of cognitive dysfunction in patients. The aim of this study was to identify patients with psychosis with intact versus impaired cognitive profiles, and to examine resting state functional connectivity between patient groups and compared to healthy controls to determine the extent to which patterns of connectivity are overlapping or distinct.
METHODS
Participants with affective or non-affective psychosis (n=120) and healthy controls (n=31) were administered the MATRICS Consensus Cognitive Battery, clinical and community functioning assessments, and an fMRI scan to measure resting state functional connectivity (RSFC). Cognitive composite scores were used to identify groups of patients with and without cognitive dysfunction. RSFC was compared between groups of patients and healthy controls, controlling for demographic and clinical variables.
RESULTS
Both cognitively intact and cognitively impaired patients showed decreased intrinsic connectivity compared to controls in frontoparietal control (FPN) and motor networks. Patients with cognitive impairment showed additional reductions in FPN connectivity compared to patients with intact cognition, particularly in subnetwork A.
CONCLUSIONS
We leveraged the heterogeneity in cognitive ability among patients with psychosis to disentangle the relative contributions of cognitive dysfunction and presence of an underlying psychotic illness using resting state functional connectivity. These findings suggest at least partially separable effects of presence of a psychotic disorder and neurocognitive impairment contributing to network dysconnectivity in psychosis.
Topics: Adult; Bipolar Disorder; Cerebral Cortex; Cognitive Dysfunction; Connectome; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Nerve Net; Psychotic Disorders; Schizophrenia; Young Adult
PubMed: 30126818
DOI: 10.1016/j.schres.2018.08.013 -
Sante Mentale Au Quebec 2021Objectives This article aims to contextualize and review interventions for patients with a clinical high-risk (CHR) state for psychosis. Method This review explores the... (Review)
Review
Objectives This article aims to contextualize and review interventions for patients with a clinical high-risk (CHR) state for psychosis. Method This review explores the literature on the CHR state and focuses more precisely on the development of its defining criteria, the evolution of CHR patients, the main interventions studied so far, and the clinical services implemented to date. Results The CHR criteria were developed from observations on the prodrome of psychotic disorders to prevent or delay the onset of psychosis. These criteria help defining three distinct groups of patients who seek help because of significant distress and functional impairments. The diagnostic evaluation remains a critical step that represents a challenge for clinicians. A significant proportion of CHR patients will not develop a psychotic disorder. And the course can be unfavorable even if there is no conversion to a psychotic disorder. In order to improve the clinical conditions of CHR patients, several interventions have been developed and studied. They fall into two main categories: psychosocial approaches and pharmacotherapy. Clinical initiatives to assess and provide support to these patients have emerged around the world, including in Switzerland, in France, and in Canada. The implementation and the integration of these services within existing health care system are influenced by several factors, including the organization of health care structures. Knowing that only a small proportion of CHR patients will progress to a psychotic disorder, it is relevant to offer these interventions in non-stigmatizing and youth-friendly places. These services would possibly be distinct from first-episode psychosis programs. Conclusion Interventions for CHR patients go well beyond the prevention of psychosis. They meet legitimate clinical needs. We must think about how to deploy them adequately in the most appropriate places.
Topics: Adolescent; France; Humans; Psychotic Disorders
PubMed: 35617495
DOI: No ID Found -
Early Intervention in Psychiatry Aug 2021There is a growing appreciation that subthreshold but clinically elevated levels of autistic traits are clinically relevant. This study examined autistic traits in...
AIM
There is a growing appreciation that subthreshold but clinically elevated levels of autistic traits are clinically relevant. This study examined autistic traits in Singaporean patients with first-episode psychosis and their association with 1-year psychosis recovery.
METHODS
The relationship between baseline patient characteristics, autistic traits (measured with autism screening questionnaires) and psychosis recovery outcomes at 1-year were examined in 180 adults in the Early Intervention Psychosis Programme in Singapore.
RESULTS
Out of 180 participants, 50 (27.8%) had clinically elevated above screening-cut off levels of autistic traits on the self-reported 10-item Autism Spectrum Quotient and 8 (4.4%) on the staff-rated Autism Spectrum Disorder in Adults Screening Questionnaire. At baseline, those with more autistic traits were more likely to be unemployed, economically inactive (ie, students or homemakers); and to have diagnoses of mood disorder with psychotic features, brief psychotic disorder or psychotic disorder not otherwise specified as compared to schizophrenia spectrum and delusional disorder diagnoses. Although most participants showed improvements in their clinical outcomes at 1-year, those with higher autistic traits improved less in the Positive and Negative Syndrome Scale general psychopathology scale and in Global Assessment of Functioning symptomatology.
CONCLUSIONS
Autistic traits are common in those with first-episode psychosis and may be associated with poorer clinical outcomes. Validated screening tools should be developed in this population to support earlier reporting.
Topics: Adult; Autism Spectrum Disorder; Autistic Disorder; Humans; Mood Disorders; Psychotic Disorders; Schizophrenia
PubMed: 32710521
DOI: 10.1111/eip.13021 -
BMC Psychiatry Sep 2019Problems in social functioning (e.g., unemployment, social isolation), are common in people with a psychotic disorder. Social cognition is a treatment target to improve...
Dynamic Interactive Social Cognition Training in Virtual Reality (DiSCoVR) for social cognition and social functioning in people with a psychotic disorder: study protocol for a multicenter randomized controlled trial.
BACKGROUND
Problems in social functioning (e.g., unemployment, social isolation), are common in people with a psychotic disorder. Social cognition is a treatment target to improve social functioning, as it is a proximal predictor of social functioning. Social Cognition Training (SCT) improves social cognition, but may not generalize (enduringly) to social functioning, perhaps due to insufficient opportunity to practice in daily-life social situations. Using virtual reality (VR) for SCT could address this problem, as VR is customizable, accessible, and interactive. We will test the effect of a VR SCT, 'DiSCoVR', on social cognition and social functioning in a randomized controlled trial (RCT).
METHODS
In total 100 people with a psychotic disorder and deficits in social cognition will be recruited for this multicenter randomized controlled trial (RCT). Participants will be randomized to VR SCT (DiSCoVR) or VR relaxation training (VRelax; active control). DiSCoVR is a 16-session individual SCT, consisting of three modules: 1) emotion perception (recognizing facial emotions in a virtual shopping street); 2) social perception and theory of mind (observing social interactions between virtual characters and assessing their behavior, emotions and thoughts); and 3) application of higher-order social cognition in social interaction (role-playing personalized situations in VR). People receiving VRelax complete sixteen individual sessions, in which they receive psycho-education about stress, identify personal stressors, learn relaxation techniques, and explore relaxing immersive virtual environments. Assessments will be performed at baseline, post-treatment, and 3-month follow-up. Primary outcomes are emotion perception (Ekman 60 Faces), social perception and theory of mind (The Awareness of Social Inference Test). Secondary outcomes include social functioning (Personal and Social Performance Scale), experiences and social interactions in daily life (experience sampling of emotions, social participation and subjective experience of social situations), psychiatric symptoms (e.g., depression, perceived stress, anxiety, positive and negative symptoms) and self-esteem.
DISCUSSION
To our knowledge, this will be the first RCT testing the efficacy of VR SCT. It will also investigate generalization to daily life social situations, the durability of treatment effects, and moderators and mediators of treatment success.
TRIAL REGISTRATION
On December 5, 2017, this trial was registered prospectively in the Dutch Trial Register as NTR6863 .
Topics: Adolescent; Adult; Aged; Female; Humans; Male; Middle Aged; Young Adult; Cognition; Cognitive Behavioral Therapy; Interpersonal Relations; Psychotic Disorders; Randomized Controlled Trials as Topic; Social Behavior; Social Participation; Social Perception; Theory of Mind; Treatment Outcome; Virtual Reality Exposure Therapy; Multicenter Studies as Topic
PubMed: 31488103
DOI: 10.1186/s12888-019-2250-0 -
Tijdschrift Voor Psychiatrie 2013The use of cannabis has been linked to an increased risk for psychosis, irrespective of confounding factors such as age, gender, use of other drugs and reverse... (Review)
Review
BACKGROUND
The use of cannabis has been linked to an increased risk for psychosis, irrespective of confounding factors such as age, gender, use of other drugs and reverse causality. Over the last few years a great deal of research has been done to broaden our understanding of the underlying mechanisms of this link.
AIM
To update studies that have examined the link between cannabis use and psychosis and that have investigated the possible mechanisms underlying this link.
METHOD
This article discusses recent epidemiological and experimental research that sheds light on the nature of the link and the influence of interactions between genes and environment.
RESULTS
The long-term effects of cannabis on the risk factors for psychosis and psychotic disorders are influenced to a large extent by genetic and environmental factors. Furthermore, patients with a psychotic disorder seem to be extremely vulnerable to the acute effects of cannabis.
CONCLUSION
Studies show that cannabis use is an important risk factor for psychosis and psychotic disorders. So far, however, less research has been done into the effects of cannabis use on patients already suffering from a psychotic disorder.
Topics: Causality; Comorbidity; Gene-Environment Interaction; Humans; Marijuana Abuse; Psychoses, Substance-Induced; Risk Factors
PubMed: 24242146
DOI: No ID Found