Cognitive Insight in Youth at Clinical High Risk of Psychosis

Introduction: Cognitive insight reflects one’s Self-Reflectiveness (recognition of dysfunctional reasoning, corrigibility) and Self-Certainty (overconfidence). In schizophrenia, lower Self-Reflectiveness and higher Self-Certainty has been associated with severity of symptoms and poor functioning. There is some evidence that lower Self-Reflectiveness and higher Self-Certainty are associated with attenuated symptoms in youth at clinical high risk (CHR) of psychosis. The present study evaluated in a CHR sample the relationship between cognitive insight and attenuated symptoms, current functioning, and evaluated change in cognitive insight at baseline and 1-month follow-up. Methods: Twenty-four individuals at CHR of psychosis completed the Beck Cognitive Insight Scale. Attenuated psychotic symptoms were assessed with the Scale of Prodromal Symptoms and functioning with the Global Functioning Social and Role scales. A subset of the sample completed the Calgary Depression Scale for Schizophrenia. Self-Reflectiveness, Self-Certainty, and Composite Index scores were correlated with clinical and functional variables. In addition, cognitive insight levels were compared at baseline and 1-month follow-up. Results: Trends were observed toward both increased attenuated perceptual abnormalities/hallucinations and higher Self-Reflectiveness, and increased avolition and increased Self-Reflectiveness. Cognitive insight did not significantly correlate with social or role functioning, or depression. Cognitive insight scores did not significantly differ between baseline and 1-month follow-up. Discussion: These findings provide little evidence for a relation between cognitive insight and clinical and functional variables in CHR, and suggest that cognitive insight remains stable over a 1-month time period in our sample. These data add to a growing body of literature on cognitive insight across the schizophrenia spectrum

Early Childhood Education Quality and Family Engagement

Empirical literature demonstrates that the quality of early childhood education (ECE) impacts children’s learning in multiple domains. Quality rating and improvement systems (QRISs), which are active in nearly every state, are designed to rate the quality of ECE programs, encourage programs to improve quality, and help families make more informed enrollment decisions. However, many families are unaware of QRISs and MD EXCELS (Maryland’s QRIS) in particular. This research study examined survey data to understand family perceptions of ECE quality and awareness of MD EXCELS. Based on these data and a review of literature, a YouTube video was implemented to increase family awareness of ECE quality and MD EXCELS and build family capacity to engage as choosers of education options. Analysis of quantitative and qualitative data suggests the YouTube video positively impacted family awareness of MD EXCELS and may have increased the likelihood that families will use quality ratings when making a future ECE enrollment decision. Qualitative data collected indicate that augmenting family decision-making models to include the effect of emotion on decisions may better represent the complexity of ECE enrollment decisions and may be useful to inform future family outreach and engagement efforts

Impact of substance use on conversion to psychosis in youth at clinical high risk of psychosis

Elevated rates of substance use (alcohol, tobacco, cannabis) have been reported in people at clinical high risk (CHR) of developing psychosis and there is some evidence that substance use may be higher in those who convert to a psychosis compared to non-converters. However little is known about the predictive value of substance use on risk of conversion to psychosis in those at CHR of psychosis. In the current study, 170 people at CHR of psychosis were assessed at baseline on severity of alcohol, tobacco and cannabis using the Alcohol and Drug Use Scale. Participants were recruited across three sites over a four year period as part of the Enhancing the Prospective Prediction of Psychosis (PREDICT) study. Predictors of conversion to psychosis were examined using Cox proportional hazards models. Results revealed that low use of alcohol, but neither cannabis use nor tobacco use at baseline contributed to the prediction of psychosis in the CHR sample. Prediction algorithms incorporating combinations of additional baseline variables known to be associated with psychotic conversion may result in increased predictive power compared with substance use alone

Patterns of premorbid functioning in individuals at clinical high risk of psychosis

In schizophrenia, four typical patterns of premorbid functioning have been observed: stable-good, stable-intermediate, poor-deteriorating and deteriorating. However, it is unknown whether similar patterns exist in those who are at clinical high risk (CHR) of psychosis. The aim of this study was to examine patterns of premorbid functioning in a large sample of individuals at CHR of psychosis and its association with symptoms, functioning, and conversion to psychosis. One-hundred sixty people at CHR of psychosis were assessed on premorbid functioning using the Premorbid Adjustment Scale. Poorer premorbid functioning was significantly correlated with worse negative symptom severity and lower social functioning. Cluster analysis was used to identify patterns of premorbid functioning. Results indicated three patterns of premorbid functioning in our CHR sample: stable-intermediate, stable-good, and deteriorating. The deteriorating group had more severe disorganization, worse negative symptoms and poorer social functioning than the other groups. Participants who made the conversion to psychosis had significantly poorer premorbid functioning during adolescence compared to those who did not convert. These results suggest that those at a clinical high risk for psychosis display similar patterns in premorbid functioning as have been observed in those with a psychotic illness and that poor premorbid functioning may be a predictor of psychosis

Relation between cannabis use and subcortical volumes in people at clinical high risk of psychosis

Among people at genetic risk of schizophrenia, those who use cannabis show smaller thalamic and hippocampal volumes. We evaluated this relationship in people at clinical high risk (CHR) of psychosis. The Alcohol and Drug Use Scale was used to identify 132 CHR cannabis users, the majority of whom were non-dependent cannabis users, 387 CHR non-users, and 204 healthy control non-users, and all participants completed magnetic resonance imaging scans. Volumes of the thalamus, hippocampus and amygdala were extracted with FreeSurfer, and compared across groups. Comparing all CHR participants with healthy control participants revealed no significant differences in volumes of any ROI. However, when comparing CHR users to CHR non-users, a significant ROI × Cannabis group effect emerged: CHR users showed significantly smaller amygdala compared to CHR non-users. However, when limiting analysis to CHR subjects who reported using alcohol at a ‘use without impairment’ severity level, the amygdala effect was non-significant; rather, smaller hippocampal volumes were seen in CHR cannabis users compared to non-users. Controlling statistically for effects of alcohol and tobacco use rendered all results non-significant. These results highlight the importance of controlling for residual confounding effects of other substance use when examining the relationship between cannabis use and neural structure

Traumatic brain injury in individuals at clinical high risk for psychosis

Recent research suggests that a traumatic brain injury (TBI) can significantly increase the risk of later development of psychosis. However, it is unknown whether people at clinical high risk (CHR) of psychosis have experienced TBI at higher rates, compared to otherwise healthy individuals. This study evaluated the prevalence of mild TBI, whether it was related to past trauma and the relationship of mild TBI to later transition to psychosis

North American Prodrome Longitudinal Study (NAPLS 2): The Prodromal Symptoms

In studies describing the long-term follow-up up of youth at clinical high risk (CHR) of psychosis, little attention has been given to details of specific prodromal symptoms. In this paper we describe the prodromal symptoms of 764 CHR participants recruited in the multi-site North American Prodrome Longitudinal Study (NAPLS). Symptoms were rated on the Scale of Prodromal Symptoms (SOPS) at baseline and 6, 12, 18 and 24 month follow-ups. Clinical outcome at the 2-year assessment was categorized as psychotic, prodromal progression, symptomatic or in remission. The majority of the CHR sample (93%) met criteria for the attenuated positive symptoms syndrome (APSS). Significant improvements in SOPS symptoms were observed overtime. Unusual thought content, disorganized communication and overall ratings on disorganized symptoms differentiated those who transitioned to psychosis from the other clinical outcome groups. Suspiciousness and total positive symptoms differentiated those in remission from the other clinical outcome groups

Evaluating the relationship between cannabis use and IQ in youth and young adults at clinical high risk of psychosis

Among people with psychosis, those with a history of cannabis use show better cognitive performance than those who are cannabis naïve. It is unknown whether this pattern is present in youth at clinical high risk (CHR) of psychosis. We evaluated relationships between IQ and cannabis use while controlling for use of other substances known to impact cognition in 678 CHR and 263 healthy control (HC) participants. IQ was estimated using the Vocabulary and Block Design subtests of the Wechsler Abbreviated Scale of Intelligence. Drug and alcohol use severity and frequency were assessed with the Alcohol and Drug Use Scale, and we inquired participants’ age at first use. CHR were further separated into early and late age at onset of cannabis use sub-groups, and low-, moderate- and high-frequency sub-groups. No significant differences in IQ emerged between CHR or HC cannabis users vs. non-users, or between use frequency groups. CHR late-onset users showed significantly higher IQ than CHR early-onset users. Age at onset of cannabis use was significantly and positively correlated with IQ in CHR only. Results suggest that age at onset of cannabis may be a more important factor for IQ than use current use or use frequency in CHR