44 research outputs found
Type and duration of subsyndromal symptoms in youth with bipolar I disorder prior to their first manic episode
Objectives: The aim of the present study was to systematically evaluate the prodrome to mania in youth. Methods: New-onset/worsening symptoms/signs of \u3e= moderate severity preceding first mania were systematically assessed in 52 youth (16.2 +/- 2.8 years) with a research diagnosis of bipolar I disorder (BD-I). Youth and/or caregivers underwent semi-structured interviews, using the Bipolar Prodrome Symptom Scale-Retrospective. Results: The mania prodrome was reported to start gradually in most youth (88.5%), with either slow (59.6%) or rapid (28.8%) deterioration, while a rapid-onset-and-deterioration prodrome was rare (11.5%). The manic prodrome, conservatively defined as requiring \u3e= 3 symptoms, lasted 10.3 +/- 14.4 months [95% confidence interval (CI): 6.3-14.4], being present for \u3e= 4 months in 65.4% of subjects. Among prodromal symptoms reported in \u3e= 50% of youth, three were subthreshold manic in nature (irritability: 61.5%, racing thoughts: 59.6%, increased energy/activity: 50.0%), two were nonspecific (decreased school/work functioning: 65.4%, mood swings/lability: 57.7%), and one each was depressive (depressed mood: 53.8%) or subthreshold manic/depressive (inattention: 51.9%). A decreasing number of youth had \u3e= 1 (84.6%), \u3e= 2 (48.1%), or \u3e= 3 (26.9%) \u27specific\u27 subthreshold mania symptoms (i.e., elation, grandiosity, decreased need for sleep, racing thoughts, or hypersexuality), lasting 9.5 +/- 14.9 months (95% CI: 5.0-14.0), 3.5 +/- 3.5 months (95% CI: 2.0-4.9), and 3.0 +/- 3.2 months (95% CI: 1.0-5.0) for \u3e= 1, \u3e= 2, or \u3e= 3 specific symptoms, respectively. Conclusions: In youth with BD-I, a relatively long, predominantly slowonset mania prodrome appears to be common, including subthreshold manic and depressive psychopathology symptoms. This suggests that early clinical identification and intervention may be feasible in bipolar disorder. Identifying biological markers associated with clinical symptoms of impending mania may help to increase chances for early detection and prevention before full mania
Functional Capacity Assessed by the Map Task in Individuals at Clinical High-Risk for Psychosis
Recent studies have recognized that signs of functional disability in schizophrenia are evident in early phases of the disorder, and, as a result, can potentially serve as vulnerability markers of future illness. However, functional measures in the psychosis prodrome have focused exclusively on real-world achievements, rather than on the skills required to carry-out a particular real-world function (ie, capacity). Despite growing evidence that diminished capacity is critical to the etiology of the established disorder, virtually no attention has been directed towards assessing functional capacity in the pre-illness stages. In the present study, we introduce the Map task, a measure to assess functional capacity in adolescent and young-adult high-risk populations
Preliminary Findings for Two New Measures of Social and Role Functioning in the Prodromal Phase of Schizophrenia
Introduction: Research on prediction and prevention of schizophrenia has increasingly focused on prodromal (prepsychosis) social and role dysfunction as developmentally early, stable, and treatment-resistant illness components. In this report, 2 new measures, Global Functioning: Social and Global Functioning: Role, are presented, along with preliminary findings about psychometric properties and course of social and role (academic/work) functioning in the prodromal phase of psychosis. Methods: Subjects included 69 participants from the Recognition and Prevention program and 52 from the Center for the Assessment and Prevention of Prodromal States. Ages ranged from 12 to 29 years, and all met criteria for Attenuated Positive Symptom syndrome. Retrospective (past year) and baseline data are reported for all 121 prodromal subjects and for 44 normal controls (NCs). Prospective follow-up data are reported for a subsample of patients reevaluated at both 6 and 12 months (N = 44). Results: For both scales, interrater reliability was high, and preliminary data supported construct validity. Relative to NCs, prodromal individuals displayed impaired social and role functioning at baseline. Analyses of change over time indicated that role functioning declined over the year before ascertainment and improved over 12-month follow-up, presumably with treatment. Social impairment, by contrast, was constant across time and predicted later psychosis (P = .002). Discussion: Using 2 new global measures, social functioning was found to be a stable trait, unchanged by treatment, with considerable potential to be a marker of schizophrenia. Role functioning, by contrast, may be a more direct barometer of clinical change and may be responsive to treatment and environmental change
Impact of Neurocognition on Social and Role Functioning in Individuals at Clinical High Risk for Psychosis
A Severity-Based Clinical Staging Model for the Psychosis Prodrome: Longitudinal Findings From the New York Recognition and Prevention Program
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M118. Functional Capacity: A New Predictor of Role Functioning in Individuals at Clinical High Risk for Psychosis
Abstract Background: Recent studies have recognized that signs of functional disability in schizophrenia are evident in early phases of the disorder, and, as a result, can potentially serve as vulnerability markers of future illness. However, functional measures in the psychosis prodrome have focused exclusively on real-world accomplishment (ie, achievement), rather than on the skills required to carry-out a particular real-world function (ie, capacity). From this perspective capacity provides the foundation for what can actually be achieved. This is comparable to the comparison between IQ (capacity) vs grades at school (achievement). In one of the first reports of its kind, we introduced the Map task, a laboratory-based measure specifically designed to assess a young person’s basic capacity to carry-out age-appropriate skills that lead to independent community living (McLaughlin et al., 2016). Poor performance on the Map task was found to be predictive of conversion to psychosis, suggesting that functional capacity in the prodrome may represent a basic biologically-based vulnerability factor. Given that diminished functional capacity is often a key barrier to good functional outcomes in patients with schizophrenia, the current study sought to next evaluate whether deficits in capacity can also predict social and role (ie, academic) functioning in the prodrome. Methods: The Map task was administered to 609 subjects at Clinical High-Risk (CHR) for psychosis and 242 Healthy Controls (HCs) participating in the North American Prodrome Longitudinal Study (NAPLS2). Subjects were required to efficiently complete a set of specified errands in a fictional town. Results: Individuals with poor role functioning at study outcome had a lower Map efficiency score than those with good role outcome. In addition, the Map efficiency score predicted role functioning at outcome (OR = −0.971, 95% CI = 0.946 to 0.997; P = .027), even after accounting for conversion status, baseline IQ, and baseline role functioning). In contrast, the Map Efficiency score did not predict social outcome (OR = 0.989, 95% CI = 0.964–1.015; P = .416), supporting previous findings that social and role functioning are 2 distinct functional domains, with different developmental courses, with each having potential to provide predictors of long-term prognosis. Conclusion: Our findings support the notion that functional capacity may well represent a distinct vulnerability factor related to the multi-faceted long-term disability typically associated with schizophrenia. Poor performance on the Map task was significantly associated with impaired role functioning at study outcome, even after controlling for the contribution of conversion and intellectual performance. Thus, deficits in both role “capacity” and role “achievement” are present before the onset of the illness, and are not an artifact of psychosis onset or intellectual impairments
DSM-5 Attenuated Psychosis Syndrome in Adolescents Hospitalized With Non-psychotic Psychiatric Disorders
Introduction: Although attenuated psychotic symptoms often occur for the first time
during adolescence, studies focusing on adolescents are scarce. Attenuated psychotic
symptoms form the criteria to identify individuals at increased clinical risk of developing
psychosis. The study of individuals with these symptoms has led to the release of
the DSM-5 diagnosis of Attenuated Psychosis Syndrome (APS) as a condition for
further research. We aimed to characterize and compare hospitalized adolescents with
DSM-5-APS diagnosis vs. hospitalized adolescents without a DSM-5-APS diagnosis.
Methods: Interviewing help-seeking, hospitalized adolescents (aged 12–18 years) and
their caregivers independently with established research instruments, we (1) evaluated
the presence of APS among non-psychotic adolescents, (2) characterized and compared
APS and non-APS individuals regarding sociodemographic, illness and intervention
characteristics, (3) correlated psychopathology with levels of functioning and severity of
illness and (4) investigated the influence of individual clinical, functional and comorbidity
variables on the likelihood of participants to be diagnosed with APS.
Results: Among 248 consecutively recruited adolescents (age=15.4 ± 1.5 years,
females = 69.6%) with non-psychotic psychiatric disorders, 65 (26.2%) fulfilled APS
criteria and 183 (73.8%) did not fulfill them. Adolescents with APS had higher number of psychiatric disorders than non-APS adolescents (3.5 vs. 2.4, p < 0.001; Cohen’s
d = 0.77), particularly, disruptive behavior disorders (Cramer’s V = 0.16), personality
disorder traits (Cramer’s V = 0.26), anxiety disorders (Cramer’s V = 0.15), and eating
disorders (Cramer’s V = 0.16). Adolescents with APS scored higher on positive (Cohen’s
d = 1.5), negative (Cohen’s d = 0.55), disorganized (Cohen’s d = 0.51), and general
symptoms (Cohen’s d = 0.84), and were more severely ill (Cohen’s d = 1.0) and
functionally impaired (Cohen’s d = 0.31). Negative symptoms were associated with lower
functional levels (Pearson ρ = −0.17 to −0.20; p = 0.014 to 0.031). Global illness
severity was associated with higher positive, negative, and general symptoms (Pearson
ρ = 0.22 to 0.46; p = 0.04 to p < 0.001). APS status was independently associated
with perceptual abnormalities (OR = 2.0; 95% CI = 1.6–2.5, p < 0.001), number of
psychiatric diagnoses (OR = 1.5; 95% CI = 1.2–2.0, p = 0.002), and impaired stress
tolerance (OR = 1.4; 95% CI = 1.1–1.7, p = 0.002) (r
2 = 0.315, p < 0.001).
Conclusions: A considerable number of adolescents hospitalized with non-psychotic
psychiatric disorders meet DSM-5-APS criteria. These help-seeking adolescents have
more comorbid disorders and more severe symptoms, functional impairment, and
severity of illness than non-APS adolescents. Thus, they warrant high intensity
clinical care.John and Maxine Bendheim FoundationAlicia Koplowitz FoundationSpanish GovernmentERDF Funds from the European Commission, A way of making Europe, CIBERSAM
PI17/02227Madrid Regional Government
B2017/BMD-3740 AGES-CM-2European Union (EU)
FP7-4-HEALTH-2009-2.2.1-2-241909
FP7-HEALTH-2013-2.2.1-2-603196
FP7-HEALTH-2013-2.2.1-2-602478European Union H2020 Program under the Innovative Medicines Initiative 2 Joint Undertaking
115916
777394Fundacion Familia AlonsoInstituto de Salud Carlos II