Overlooking the transition elephant in the ultra-high-risk room: are we missing functional equivalents of transition to psychosis?

AbstractIn the wake of the almost quarter of a century since the conceptualization of ultra-high-risk (UHR) states for psychosis, empirical evidences in the field are constantly scrutinized and re-assessed through meta-analytic lens. Briefly, such scrutiny converges on three major evidences: pretest risk enrichment, risk hierarchy within UHR states, and declining transition rates. While the former two are intuitive, the dilution effect remains elusive and might be rather symptomatic of unsolved issues in the field. Those include the heterogeneously reported antipsychotic (AP) exposure in UHR samples and the almost univocal focus on purely psychometric transition to psychosis. Both issues lead to the neglect of functional equivalents of transition, i.e. that of a mental state at immediate need for AP medication, and might have a cascading confounding effect on the predictive value of contemporary risk calculators centered on criterial transition as a unique outcome

Editorial Perspective: Psychosis risk in adolescence – outcomes, comorbidity, and antipsychotics

Research on Clinical High‐Risk for Psychosis (CHR‐P) has led to a vigorous change in the field of early detection in psychiatry and is gradually expanding its focus toward early development. The Annual Research Review on psychosis risk in adolescents (Journal of Child Psychology and Psychiatry, 62, 2020 and 657) offers a wide‐angle meta‐analytical picture of such emerging trends in all areas relevant to CHR‐P Research, that is, detection, prognosis, and intervention. This editorial perspective is meant to expand the clinical and conceptual reach of these meta‐analytic findings in relation to (a) the influence of age on transition rate and scalability of the early detection model across the child–adolescent vs adult periods; (b) potential latent heterogeneity of the pathogenetic trajectories leading to CHR‐P as suggested by comorbid psychopathologies; (c) controversial (or at least problematic) prognostic significance of antipsychotic exposure in CHR‐P subjects, especially in children and adolescents

ANHEDONIA IN THE PSYCHOSIS RISK SYNDROME: STATE AND TRAIT CHARACTERISTICS

Background: Previous studies reported deficits in pleasure experience in schizophrenia, but little is known about anhedonia in psychosis risk syndrome. Aim of this study was: (1) to assess anhedonia in distinct help-seeking subgroups of young people identified through the Ultra-High Risk (UHR) criteria, (2) to explore its association with functioning and psychopathology in the UHR group, and (3) to monitor longitudinally its stability in UHR individuals along 1-year follow-up period. Subjects and methods: All participants (78 UHR, 137 with a First Episode Psychosis (FEP), and 95 non-UHR/FEP), aged 13-35 years, completed the Comprehensive Assessment of At-Risk Mental States (CAARMS), the Beck Depression Inventory-II (BDI-II), the Schizotypal Personality Questionnaire - Brief version (SPQ-B), the Brief O-LIFE questionnaire (BOL), and the World Health Organization Quality of Life - Brief version (WHOQOL-BREF). We adopted two different indexes of anhedonia: i.e. CAARMS “Anhedonia” item 4.3 and BOL “Introvertive Anhedonia” subscale scores. Results: In comparison with non-UHR/FEP, UHR individuals showed higher baseline CAARMS item 4.3 and BOL “Introvertive Anhedonia” subscale scores. No difference in anhedonia scores between UHR and FEP patients was found. After 1-year follow up period, UHR subjects had a significant decrease in severity exclusively on CAARMS item 4.3 subscore. Conclusions: In the UHR group, CAARMS anhedonia showed significant correlations with functioning deterioration, negative symptoms, and comorbid depression (including suicide ideation), while BOL anhedonia with a poorer self-perceived quality of life and specific schizotypal personality traits (i.e. interpersonal deficits and disorganization). Anhedonia is prominent in the psychosis risk syndrome and its severity is indistinguishable from that of FEP patients

Anhedonia and suicidal ideation in young people with early psychosis: Further findings from the 2-year follow-up of the ReARMS program.

Hedonic deficits have been extensively studied in schizophrenia, but little is known about their association with suicidal ideation in early psychosis. The aim of this research was to examine the relationship between anhedonia and suicidal thoughts across a 2-year follow-up period in people with First Episode Psychosis (FEP) and at Ultra High Risk (UHR) of psychosis. Ninty-six UHR and 146 FEP, aged 13–35 years, completed the Comprehensive Assessment of At-Risk Mental States (CAARMS) and the Beck Depression Inventory-II (BDI-II). The BDI-II “Anhedonia” subscale score to assess anhedonia and the CAARMS “Depression” item 7.2 subscore to measure depression were used across the 2 years of follow-up. Hierarchical regression analyses were performed. No difference in anhedonia scores between FEP and UHR individuals was found. In the FEP group, a significant enduring association between anhedonia and suicidal ideation was found at baseline and across the follow-up, independent of clinical depression. In the UHR subgroup, the enduring relationship between anhedonia and suicidal thoughts were not completely independent from depression severity. Anhedonia is relevant in predicting suicidal ideation in early psychosis. Specific pharmacological and/or psychosocial interventions on anhedonia within specialized EIP program could reduce suicide risk overtime

Quick identification of the risk of psychosis: the Italian version of the prodromal questionnaire-brief

Background: Diagnosing people during the prodromal phase of an incipient psychosis can improve the chance of better outcome. In busy clinical settings, the ideal tool is a brief, easy-to-complete self-report questionnaire. Objective: To test the psychometric properties of the Italian version of one of the most used screening tools for the identification of the risk of psychosis, the Prodromal Questionnaire-Brief (PQ-B). Methods: Cross-sectional design. A convenience sample of college students was enrolled via snowball procedure (n=243; men: 45%). After understanding and signing the consent form, the participants received a booklet containing the following questionnaires: the 21-item Prodromal Questionnaire-Brief (PQ-B); the 12-item General Health Questionnaire (GHQ-12), and the 74-item Schizotypal Personality Questionnaire (SPQ). Receiver operating characteristic (ROC) analysis was used to assess the capacity of the PQ-B to identify individuals at risk of psychosis as independently defined based on the combination of GHQ-12 and SPQ thresholds. Results: The Italian version of the PQ-B revealed good internal consistency, test-retest reliability, and adequate convergent and divergent validity. The Youden method retrieved a cut-off = 7 for the PQ-B frequency score and a cut-off = 22 for the PQ-B distress score. Both PQ-B scores had a perfect (99%) negative predictive value. Conclusion: The PQ-B is a promising screening tool in two-stage protocols. The major advantage of the PQ-B is to exclude cases that are unlikely to be at risk of psychosis

Introduction

Introduction to The Oxford Handbook of Phenomenological Psychopathology

Hallucinations Beyond Voices : A Conceptual Review of the Phenomenology of Altered Perception in Psychosis

Recent psychiatric research and treatment initiatives have tended to move away from traditional diagnostic categories and have focused instead on transdiagnostic phenomena, such as hallucinations. However, this emphasis on isolated experiences may artificially limit the definition of such phenomena and ignore the rich, complex, and dynamic changes occurring simultaneously in other domains of experience. This article reviews the literature on a range of experiential features associated with psychosis, with a focus on their relevance for hallucinations. Phenomenological research on changes in cognition, perception, selfhood and reality, temporality, interpersonal experience, and embodiment are discussed, along with their implications for traditional conceptualizations of hallucinations. We then discuss several phenomenological and neurocognitive theories, as well as the potential impact of trauma on these phenomena. Hallucinations are suggested to be an equifinal outcome of multiple genetic, neurocognitive, subjective, and social processes; by grouping them together under a single, operationalizable definition, meaningful differences in etiology and phenomenology may be ignored. It is suggested that future research efforts strive to incorporate a broader range of experiential alterations, potentially expanding on traditional definitions of hallucinations. Relevance for clinical practice, including emphasizing phenomenologically responsive techniques and developing targeted new therapies, is discussed