Twelve-month psychosis-predictive value of the ultra-high risk criteria in children and adolescents

Objective The validity of current ultra-high risk (UHR) criteria is under-examined in help-seeking minors, particularly, in children below the age of 12 years. Thus, the present study investigated predictors of one-year outcome in children and adolescents (CAD) with UHR status. Method Thirty-five children and adolescents (age 9–17 years) meeting UHR criteria according to the Structured Interview for Psychosis-Risk Syndromes were followed-up for 12 months. Regression analyses were employed to detect baseline predictors of conversion to psychosis and of outcome of non-converters (remission and persistence of UHR versus conversion). Results At one-year follow-up, 20% of patients had developed schizophrenia, 25.7% had remitted from their UHR status that, consequently, had persisted in 54.3%. No patient had fully remitted from mental disorders, even if UHR status was not maintained. Conversion was best predicted by any transient psychotic symptom and a disorganized communication score. No prediction model for outcome beyond conversion was identified. Conclusions Our findings provide the first evidence for the predictive utility of UHR criteria in CAD in terms of brief intermittent psychotic symptoms (BIPS) when accompanied by signs of cognitive impairment, i.e. disorganized communication. However, because attenuated psychotic symptoms (APS) related to thought content and perception were indicative of non-conversion at 1-year follow-up, their use in early detection of psychosis in CAD needs further study. Overall, the need for more in-depth studies into developmental peculiarities in the early detection and treatment of psychoses with an onset of illness in childhood and early adolescence was further highlighted

Dream interpretation: a possible diagnostic method during the “prodromal” phase of psychosis

Prevention of psychosis faces two challenges: the accurate identification of the target population and their effective treatment. Psychological interventions are considered first line treatment in HR individual. Cognitive behaviour therapy demonstrated to reduce transition to about 50% but there are no improvements in negative symptoms and social functioning. The aim of the present study was to discuss a psychotherapeutic psychodynamic approach for young individuals at risk for severe mental illnesses. Help-seekers individuals aged 14–35 referred to psychotherapeutic Unit Villa Tiburtina, Sapienza University of Rome were recruited in the study. Subjects involved completed SIPS, COPER and COGDIS, EASE, GFSS, GFRS. Weekly sessions of psychodynamic psychotherapy were offered to eligible subjects. The hypothesis was that a psychodynamic approach may be useful both for the detection and treatment of young subjects at risk. Going beyond the evident symptoms and comprehending the latent components of thought may permit to deeper differentiate subtle initial prodromal symptoms from transient psychological ups and downs of human growing up. It might also approach the psychopathological core of the initial disease and treat it

Diagnostic distribution of self-disorders in help-seeking adolescents: an early faeature of the schizophrenia spectrum

Self-disorders (SD) have been considered as a core feature of schizophrenia in both classical and recent psychopathological literature. However, the specificity of SD to the schizophrenia spectrum has mainly been tested in adult samples, with studies in adolescents being scarce. Thus, the aims of this study were: 1) to examine the specificity of SD to the schizophrenia spectrum in a help-seeking adolescent sample; 2) to explore the correlations between SD and social and role functioning. One hundred 13-18-year-old inpatients underwent a comprehensive psychopathological examination. SD were assessed using the Examination of Anomalous Self-Experiences (EASE), and social and role functioning were assessed using the Global Functioning: Social (GF:S) and Role (GF:R) scales. The diagnostic distribution of the EASE scores was tested using Mann–Whitney U test, the correlations between the EASE scores and the GF:S and GF:R scores were tested using Spearman's ρ. EASE scores were significantly higher in schizophrenia spectrum disorders than in other spectrum disorders, whereas in schizophrenia spectrum psychoses and schizotypal personalities did not differ. Furthermore, higher EASE scores significantly correlated with lower GF:S and GF:R scores. This findings confirm the validity of SD as an experiential vulnerability phenotype of the schizophrenia spectrum, even in adolescents

Youth mental health services in Italy. an achievable dream?

Abstract AIM: "Liberiamo il futuro" (LIF) project was designed to assess psychological problems of adolescents and young adults and to identify individuals at high-risk for developing a psychosis through a collaboration between a University team, Child and Adolescent Mental Health Services and Adult Mental Health Services. This paper presents the baseline demographic and clinical characteristics of the cohort, particularly the nature and severity of psychopathology. METHOD: All help-seeking young people aged 12-35 years residing in the health district involved in LIF were invited to participate in the study and completed a battery of self- report and interviewer-administered measures of psychopathology and functioning at baseline. RESULTS: A total of 338 adolescents and young people (mean age 17.42) participated in the study. The majority of the sample (n = 107, 35%) had an anxiety disorder, followed by mood disorders (n = 62, 21%). Only 35 (12%) participants had no psychiatric diagnosis. After a screening phase, 166 (52%) individuals were assessed to detect the presence of an Ultra High Risk (UHR) state. Of these, 38.60% (n = 64) met UHR criteria. Overall, the majority of the sample resulted moderately functionally impaired at baseline. CONCLUSIONS: LIF project showed that psychological problems, associated with impaired psychosocial functioning, are very common among help-seeking young people. The help-seeking behaviour of young people is in contrast with the barriers presented by the Italian community mental health system that is modelled around adults' requirements. A need of a strong, stigma-free, young oriented system of care for young people up to the mid-20s emerged.AIM: "Liberiamo il futuro" (LIF) project was designed to assess psychological problems of adolescents and young adults and to identify individuals at high-risk for developing a psychosis through a collaboration between a University team, Child and Adolescent Mental Health Services and Adult Mental Health Services. This paper presents the baseline demographic and clinical characteristics of the cohort, particularly the nature and severity of psychopathology. METHOD: All help-seeking young people aged 12-35 years residing in the health district involved in LIF were invited to participate in the study and completed a battery of self- report and interviewer-administered measures of psychopathology and functioning at baseline. RESULTS: A total of 338 adolescents and young people (mean age 17.42) participated in the study. The majority of the sample (n = 107, 35%) had an anxiety disorder, followed by mood disorders (n = 62, 21%). Only 35 (12%) participants had no psychiatric diagnosis. After a screening phase, 166 (52%) individuals were assessed to detect the presence of an Ultra High Risk (UHR) state. Of these, 38.60% (n = 64) met UHR criteria. Overall, the majority of the sample resulted moderately functionally impaired at baseline. CONCLUSIONS: LIF project showed that psychological problems, associated with impaired psychosocial functioning, are very common among help-seeking young people. The help-seeking behaviour of young people is in contrast with the barriers presented by the Italian community mental health system that is modelled around adults' requirements. A need of a strong, stigma-free, young oriented system of care for young people up to the mid-20s emerged

Interpersonal sensitivity, bullying victimization and paranoid ideation among help-seeking adolescents and young adults

Aim: The effects of a negative interpersonal experience, such as bullying victimization in childhood and adolescence, can be strong and long lasting. Bullying victimization is associated with paranoid ideation and suspiciousness. Few studies have focused on personality traits of victims of bullying. The aim of this study is to investigate whether a particular personality trait called interpersonal sensitivity may be related to suspiciousness in those who experienced bullying victimization. Methods: The study sample consisted of 147 help-seeking adolescents (mean age 17 years) selected after a screening phase (Prodromal Questionnaire) and evaluated with the Structured Interview for Psychosis-risk Syndromes (SIPS). All participants were specifically asked if they had experienced either psychological bullying or physical bullying, and they completed the Interpersonal Sensitivity Measure (IPSM). Results: Of the whole sample, 30 (20%) participants had experienced psychological bullying or physical bullying at least once in their life. Performing a multiple regression, bullying victimization was found to be an independent predictor of subtle paranoid ideation and suspiciousness. Interpersonal sensitivity was also found to be an independent predictor of subtle paranoid ideation; in particular, two IPSM subscales, fragile inner-self and separation anxiety, showed a significant correlation with subtle paranoid ideation. Conclusions: Our results confirmed that bullying victimization is a negative interpersonal experience associated with paranoid ideation and suspiciousness. However, being overly sensitive and having negative beliefs about the self as fragile and vulnerable to threat also lead to a tendency to attribute experiences as externally caused and, in turn, facilitate the formation and maintenance of paranoid ideation

Self-disorders and clinical high risk for psychosis: an empirical study in help-seeking youth attending community mental health facilities

Anomalous subjective experiences involving an alteration of the basic sense of self (ie, Self-disorder [SD]) are emerging as a core marker of schizophrenia spectrum disorders with potential impact on current early detection strategies as well. In this study, we wished to field-test the prevalence of SD in a clinical sample of adolescent/young adult help-seekers at putative risk for psychosis attending standard community mental health facilities in Italy. Participants (n = 47), aged between 14 and 25, underwent extensive psychopathological evaluations with current semi-structured tools to assess Clinical High Risk (CHR) state (ie, Structured Interview for Prodromal Syndromes/Scale of Prodromal Symptoms (SIPS/SOPS], Schizophrenia Proneness Instrument-Adult/Child and Youth [SPI-A/ CY]). SD aggregated in CHR subjects as compared to the non-CHR and revealed substantial association with sub-psychotic symptoms (SIPS), subjective experience of cognitive and cognitive-perceptual vulnerability (basic symptoms) and functional level (Global Assessment of functioning). Moreover, a combination of the 2 approaches (ie, CHR plus SD) enabled further “closing-in” on a subgroup of CHR with lower global functioning. The results confirm SD’s relevance for the early profiling of youths at potential high risk for psychosis

Interpersonal sensitivity and attenuated psychotic symptoms: a prediction model

Interpersonal sensitivity (IS) defines feelings of inner-fragility in the presence of others due to the expectation of criticism or rejection. IS was found to be related to attenuated positive psychotic symptom during the prodromal phase of psychosis. The aims of this study were to examine if high level of IS at baseline predict persistence of subtle positive psychotic symptoms at follow up and its relationship with other longitudinal psychopathological features. A sample of 103 subjects taken from the total baseline sample (367 adolescents and young adults help-seekers for psychological problems recruited within “Liberiamo il futuro” project) completed a 18-months follow up. Of these, 84 completed the Interpersonal Sensitivity Measure (IPSM) and the Structured Interview for Prodromal Symptoms (SIPS) at baseline; they were assessed again with the SIPS at follow up. Result showed that individuals with high level of IS at baseline reported high level of attenuated positive psychotic symptoms (i.e. unusual thought content), symptoms of depression and low tolerance to daily stressful events at follow up. This study suggests that being “hypersensitive” to interpersonal interactions is a psychological feature associated with attenuated positive psychotic symptoms, symptoms of depression and low tolerance to daily stressful events at 18-moths follow up. Assessing and treating inner-self fragilities may be an important step of early detection program to avoid the persistence of subtle but very distressing long-terms symptoms