LATENT PROFILE ANALYSIS AND CONVERSION TO PSYCHOSIS: CHARACTERIZING SUBGROUPS TO ENHANCE RISK PREDICTION

Background: Groups at clinical high risk (CHR) of developing psychosis are heterogeneous, composed of individuals presenting with several different clusters of diagnostic symptoms (e.g., affective symptoms, anxiety symptoms, subpsychotic symptoms). It is likely that there are subgroups within those at CHR, each associated with different constellations of symptoms and associated probabilities of conversion. Method: Latent Profile Analysis (LPA) has shown promise in identifying subgroups with clinically useful profiles of risk indicators among CHR individuals. The current study used a LPA model to ascertain subgroups in a combined sample of CHR (n = 171) and help-seeking controls (HSC; n = 100). Indicators in the LPA model included baseline Scale of Prodromal Symptoms (SOPS), total depressive symptoms (CDSS), and neurocognitive performance. Subgroups were further characterized using covariates measuring demographic and clinical features. General linear mixed models for repeated measures were used to examine within group change over time and longitudinal subgroup comparisons on a measure of social functioning. Results: LPA resulted in three classes: class 1 (mild) had the lowest transition risk (5.6%), the lowest scores across SOPS symptoms and depression scores, and intact neurocognitive performance; class 2 (positive-depressive) had a transition risk of 14.2%, the highest positive symptoms, mild or lesser negative symptoms, and moderate depression; class 3 (negative-neurocognitive) had the highest transition risk (29.3%), the highest negative symptoms, neurocognitive impairment, and social cognitive impairment. Classes 2 and 3 evidenced similarly poor social functioning. Conclusions: Results support a subgroup approach to the research, assessment, and treatment of help seeking individuals. Three classes emerged with good separation on a majority of indicator variables, including a class that may be an early manifestation of the deficit subtype. Development of efficacious treatments for early neurocognitive deficits and negative symptoms are indicated. Results underline the profound social dysfunction across help seeking individuals and need for improved treatments.Doctor of Philosoph

Observable Social Cognition: A Rating Scale: An Interview-Based Assessment for Schizophrenia

Individuals with schizophrenia consistently show impairments in social cognition (SC). Current SC measures are hampered by methodological issues that limit use of SC as a viable treatment target. An alternative assessment method is to administer a scale incorporating an informant's impressions. The Observable Social Cognition: A Rating Scale (OSCARS) was administered to 62 outpatients and 50 non-psychiatric controls (NPCs) to assess SC performance. OSCARS demonstrated sufficient internal consistency and test-retest reliability. Construct validity was assessed through exploratory factor analysis. Patient OSCARS scores were not significantly correlated with measures of SC, with the exception of aggressive attributional style. Results indicated individuals with less impairment in SC reacted more aggressively to ambiguous situations. Control OSCARS scores were significantly correlated with measures of theory of mind and attributional style. In patients, OSCARS was significantly correlated with several measures of functioning and neurocognition. Implications for using OSCARS as an outcome measure will be discussed.Master of Art

Social cognition in schizophrenia: factor structure, clinical and functional correlates

Social cognition is consistently impaired in people with schizophrenia, separable from general neurocognition, predictive of real-world functioning, and amenable to psychosocial treatment. Few studies have empirically examined its underlying factor structure

Theory of mind and social judgments in people at clinical high risk of psychosis

Social cognitive deficits are consistently reported in psychotic populations. Few studies have longitudinally investigated social cognition in clinical high-risk (CHR) populations

The Social Cognition Psychometric Evaluation Study: Results of the Expert Survey and RAND Panel

Background: In schizophrenia, social cognition is strongly linked to functional outcome and is increasingly seen as a viable treatment target. The goal of the Social Cognition Psychometric Evaluation (SCOPE) study is to identify and improve the best existing measures of social cognition so they can be suitably applied in large-scale treatment studies. Initial phases of this project sought to (1) develop consensus on critical domains of social cognition and (2) identify the best existing measures of social cognition for use in treatment studies. Methods: Experts in social cognition were invited to nominate key domains of social cognition and the best measures of those domains. Nominations for measures were reduced according to set criteria, and all available psychometric information about these measures was summarized and provided to RAND panelists. Panelists rated the quality of each measure on multiple criteria, and diverging ratings were discussed at the in-person meeting to obtain consensus. Results: Expert surveys identified 4 core domains of social cognition—emotion processing, social perception, theory of mind/mental state attribution, and attributional style/bias. Using RAND panel consensus ratings, the following measures were selected for further evaluation: Ambiguous Intentions Hostility Questionnaire, Bell Lysaker Emotion Recognition Task, Penn Emotion Recognition Test, Relationships Across Domains, Reading the Mind in the Eyes Test, The Awareness of Social Inferences Test, Hinting Task, and Trustworthiness Task. Discussion: While it was possible to establish consensus, only a limited amount of psychometric information is currently available for the candidate measures, which underscores the need for well-validated and standardized measures in this area

Observable Social Cognition – A Rating Scale: an interview-based assessment for schizophrenia

Individuals with schizophrenia consistently show impairments in social cognition (SC). SC has become a potential treatment target due to its association with functional outcomes. An alternative method of assessment is to administer an observer-based scale incorporating an informant’s “first hand” impressions in ratings

The Social Cognition Psychometric Evaluation Study: Results of the Expert Survey and RAND Panel

Background: In schizophrenia, social cognition is strongly linked to functional outcome and is increasingly seen as a viable treatment target. The goal of the Social Cognition Psychometric Evaluation (SCOPE) study is to identify and improve the best existing measures of social cognition so they can be suitably applied in large-scale treatment studies. Initial phases of this project sought to (1) develop consensus on critical domains of social cognition and (2) identify the best existing measures of social cognition for use in treatment studies. Methods: Experts in social cognition were invited to nominate key domains of social cognition and the best measures of those domains. Nominations for measures were reduced according to set criteria, and all available psychometric information about these measures was summarized and provided to RAND panelists. Panelists rated the quality of each measure on multiple criteria, and diverging ratings were discussed at the in-person meeting to obtain consensus. Results: Expert surveys identified 4 core domains of social cognitionemotion processing, social perception, theory of mind/mental state attribution, and attributional style/bias. Using RAND panel consensus ratings, the following measure

Male breast cancer in BRCA1 and BRCA2 mutation carriers : pathology data from the Consortium of Investigators of Modifiers of BRCA1/2

Background: BRCA1 and, more commonly, BRCA2 mutations are associated with increased risk of male breast cancer (MBC). However, only a paucity of data exists on the pathology of breast cancers (BCs) in men with BRCA1/2 mutations. Using the largest available dataset, we determined whether MBCs arising in BRCA1/2 mutation carriers display specific pathologic features and whether these features differ from those of BRCA1/2 female BCs (FBCs). Methods: We characterised the pathologic features of 419 BRCA1/2 MBCs and, using logistic regression analysis, contrasted those with data from 9675 BRCA1/2 FBCs and with population-based data from 6351 MBCs in the Surveillance, Epidemiology, and End Results (SEER) database. Results: Among BRCA2 MBCs, grade significantly decreased with increasing age at diagnosis (P = 0.005). Compared with BRCA2 FBCs, BRCA2 MBCs were of significantly higher stage (P for trend = 2 x 10(-5)) and higher grade (P for trend = 0.005) and were more likely to be oestrogen receptor-positive [odds ratio (OR) 10.59; 95 % confidence interval (CI) 5.15-21.80] and progesterone receptor-positive (OR 5.04; 95 % CI 3.17-8.04). With the exception of grade, similar patterns of associations emerged when we compared BRCA1 MBCs and FBCs. BRCA2 MBCs also presented with higher grade than MBCs from the SEER database (P for trend = 4 x 10(-12)). Conclusions: On the basis of the largest series analysed to date, our results show that BRCA1/2 MBCs display distinct pathologic characteristics compared with BRCA1/2 FBCs, and we identified a specific BRCA2-associated MBC phenotype characterised by a variable suggesting greater biological aggressiveness (i.e., high histologic grade). These findings could lead to the development of gender-specific risk prediction models and guide clinical strategies appropriate for MBC management.Peer reviewe

Theory of mind and social judgments in people at clinical high risk of psychosis

BACKGROUND: Social cognitive deficits are consistently reported in psychotic populations. Few studies have longitudinally investigated social cognition in clinical high-risk (CHR) populations. AIMS: Longitudinally examine theory of mind (ToM) and social judgments in a CHR sample to investigate stability of performance over time and potential ability to predict conversion to psychosis. METHOD: 147 CHR individuals and 85 help seeking controls (HSC) were assessed for up to 2 years; 28 participants developed psychosis across both groups. Generalized linear mixed models for repeated measures was used to examine change over time for ratings on the three social cognitive indices of ToM, trustworthiness, and approachability. Hierarchical regression was used to test whether social cognitive variables explain more variance in conversion than IQ. RESULTS: CHR individuals showed a positive bias in approachability judgments over time compared to HSC. Baseline ToM performance significantly (p<.05) predicted later conversion beyond IQ scores. These results were attenuated when controlling for baseline symptom level. CONCLUSIONS: Although ToM deficits might predate conversion to psychosis; one must consider initial symptoms as well. Social judgments were not associated with conversion to schizophrenia