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

Personality and attachment patterns in a clinical sample of adolescents at ultra-high risk for psychosis

The ultra-high risk (UHR) criteria were defined to identify young people at imminent risk of developing a first episode of psychosis. Identifying UHR individuals can help guide mental health practitioners in their treatment decision-making and adapt their interventions to the individual characteristics of patients in order to prevent the onset of psychosis. To date, only few studies have focused on personality features of the UHR patients’ population, using mostly self-report instruments despite their crucial limitations in this field. Moreover, very little research has examined the link between the risk for developing psychosis and insecure attachment. Notably, no empirical investigations have studied this relationship using the gold standard measure for attachment. This study aimed at examining with valid and reliable measures both personality features and attachment patterns in a clinical sample of UHR adolescents. Methods: 40 adolescent UHR outpatients were compared to 40 individuals who didn’t meet the ultra-high risk criteria. Each patient received a DSM personality diagnosis and was assessed using the Brief Psychiatric Rating Scale (BPRS) and Structured Interview for Prodromal Syndromes (SIPS/SOPS), the Shedler-Westen Assessment Procedure (SWAP-200-A), as well as the Adult Attachment Interview (AAI). Results: No differences between groups have been found when personality disorders were measured according to the DSM-IV-TR categories. However, UHR patients showed more impaired personality functioning and higher scores on two Q-factors of the SWAP-200: “inhibited/self- critical” and “emotionally dysregulated”. Finally, a higher degree of “cannot classify low- coherence” attachment patterns was found in UHR patients’ group. Conclusions: These primary findings seem to suggest the importance of taking into account the emotional dysregulation, social inhibition and disorganized attachment in treatment planning of UHR patients

Clinical assessment of personality and attachment patterns in adolescents at ultra high risk for psychosis

Introduction: “Ultra-high risk” (UHR) diagnostic criteria (Miller et al., 2003) pinpoint a combination of state (attenuated or brief intermittent positive psychotic symptoms) and trait (genetic risk with a deterioration in functioning) risk factors that identify youth and young adults at heightened and imminent risk of developing a first episode of psychosis. Identifying UHR individuals can help guide mental health practitioners in their treatment decision-making and adapt their interventions to the individual characteristics of patients in order to prevent the onset of psychosis. Nevertheless, UHR population is highly heterogeneous, displaying varying clinical conditions, including anxiety, depression and substance disorders. As this heterogeneity undermines both clinical research and the evaluation and treatment of patients, many mental health care providers ex- press concern with the current diagnostic practice, which does not enable efficacious therapeutic planning. In particular, according to epidemiological data, has been shown that about 40% of UHR patients receive at least one diagnosis of personality disorder. Although some common genetic and environmental diatheses underlie both schizotypal personality disorders and schizophrenia, some studies have shown the rates of schizotypal UHR patients to be relatively modest. In contrast, other studies have found a considerable prevalence of schizoid, borderline and avoidant personality traits/disorders among UHR patients (Shurze-Lutter et al., 2012). So far, only few studies have thus evaluated personality features in the UHR population, suggesting that the personality characteristics of such patients vary considerably. To our knowledge, these personality differences have never been systematically evaluated. Furthermore, there are evidences linking attachment adversity to psychosis, from the premorbid stages of the disorder to its clinical forms. To date, very little research has evaluated attachment patterns in UHR individuals. In each case, the researchers used exclusively self-report instruments and detected a high rate of insecure patterns (e.g., 93% in Quijada et al., 2015; and 95% in Russo et al., 2018). We consider a systematic investigation of the UHR population critical for improving our understanding of the different symptom patterns of UHR individuals and achieving more accurate diagnoses. We aim to conduct such an investigation by: (1) examining the full spectrum of person-specific psychopathology and its manifestation in patient personality structures, under the assumption that symptoms take different meanings and roles according to the larger context of patient personality functioning. (2) investigating attachment patterns using the gold standard measure for attachment. Methods: 40 adolescent UHR outpatients were compared to 40 individuals who didn’t meet the ultra-high risk criteria. The recruited patients’ treating clinicians were also involved and asked to provide basic demo- graphic and diagnostic data, and to complete clinician-report assessment tools. Each patient received a DSM personality diagnosis and was assessed using the Brief Psychiatric Rating Scale (BPRS). The Structured Interview for Prodromal Syndromes (SIPS/SOPS) has been administered to assess prodromal symptoms. According to the SIPS, UHR participants must meet one of three criteria: (1) increasing but attenuated positive symptoms; (2) a recent, brief psychotic episode that is too short in duration to meet diagnostic criteria for a psychosis disorder; or (3) a first-degree relative with psychosis, and recent functional decline. The Adult Attachment Interview (AAI), a semi-structured interview used to assess individuals’ “state of mind” or internal working models with respect to attachment relationships, was administered to each patient. The AAI interviews have been audio recorded, transcribed verbatim, and coded by two independent certified coders who were blind to all other study conditions. Childhood trauma has been coded from the verbatim transcripts of the AAI by two independent raters, according to the clinical version of the Complex-TQ, a questionnaire aimed to assess multi-dimensional features of childhood trauma. Finally, treating clinicians were supervised by the researchers for evaluate patients’ personality trait and disorders, according to the SWAP-200, a well- established and widely used psychometric procedure that provides a comprehensive assessment of personality and personality pathology. Results: No differences between groups have been found when personality disorders were measured according to the DSM-IV-TR categories. However, UHR patients showed more impaired personality functioning and higher scores on two Q-factors of the SWAP- 200: “inhibited/self-critical” and “emotionally dysregulated”. Finally, a higher degree of “cannot classify low-coherence” attachment pat- terns was found in UHR patients’ group. Conclusions: These primary findings seem to suggest the importance of taking into account the emotional dysregulation, social inhibition and disorganized attachment in treatment planning of UHR patients. To date, the intervention strategies available to significantly change the clinical course of UHR conditions have proven to be poorly effective in follow-ups longer than 12 months (Davies et al., 2018). Preliminary results this study seem to suggest that attachment-informed psychotherapy, tailored to the personality characteristics of patients, may be an effective preventive treatment for UHR patients

An Overview of Recent Findings on Social Anxiety Disorder in Adolescents and Young Adults at Clinical High Risk for Psychosis

Background: Some studies have shown that anxiety is particularly frequent in the Clinical High Risk (CHR) for psychosis population. Notably, social anxiety disorder is identified as one of the most common anxiety disorders in CHR adolescents and young adults. Despite this, the frequency and the clinical significance of social anxiety in this population have been underestimated. Methods: A selective review of literature published between 2011 and 2017 on social anxiety disorder in CHR adolescents and young adults. Results: Five studies are included. In particular, three studies demonstrated that CHR adolescents and young adults have higher levels of anxiety compared to controls. Furthermore, anxiety, including social anxiety, is related to the severity of psychotic symptoms. The other studies included show inconsistent results regarding the possible relationship between social anxiety and social functioning. Conclusions: To date, the eidence concerning the comorbidity of social anxiety disorder and CHR in adolescents and young adults is not sufficient to provide clear guidelines for clinical practice. Future longitudinal studies on larger samples of the CHR adolescents and young adults are required to examine the relationship between social anxiety disorder and the presence of attenuated psychotic symptomatology

Novel psychoactive substances as a novel challenge for health professionals: results from an Italian survey

INTRODUCTION: Novel psychoactive substances (NPS; a.k.a. 'legal highs' or 'smart drugs') are advertised online as 'safe' and 'legal' natural/synthetic analogues of controlled illicit drugs. However, only little research has been carried out in identifying the health professionals' knowledge and expertise relating to the intake of these compounds. METHODS: Data presented here refer to the Italian component of the European Union-wide, European Commission-funded, ReDNet project survey. An ad-hoc questionnaire was administered to professionals from the departments of Addiction, Psychiatry, Paediatrics and Emergency Room Services in Italy. RESULTS: The interviewees' sample included 243 professionals, mostly from the departments of Addiction (35%) and Psychiatry (28.4%). Overall, interviewees self-reported a poor technical knowledge relating to NPS; some 27% of respondents confirmed of not being aware if their patients presented with a previous history of NPS misuse. DISCUSSION: Novel psychoactive substances prevalence of misuse was not considered to be an unusual phenomenon in Italy, and most health professionals appeared to have concerns relating to associated medical and psychopathological risks, especially in terms of aggression/psychomotor agitation. Overall, most respondents reported the need to have better access to NPS-related reliable sources of information

Prevalence and Clinical Significance of Symptoms at Ultra High Risk for Psychosis in Children and Adolescents with Obsessive⁻Compulsive Disorder: Is There an Association with Global, Role, and Social Functioning?

In literature nothing is known about the clinical significance of Ultra High Risk (UHR) symptoms in children and adolescents with diagnosis of obsessive⁻compulsive disorder (OCD). In this study, we examined the prevalence of UHR symptoms and their relationship with severity of obsessive⁻compulsive symptomatology, global, social, and role functioning, and level of associated depressive symptoms in a clinical sample (n = 51) of children and adolescents aged between 8 and 17 years with a diagnosis of OCD. The prevalence of UHR symptoms in this sample was 43.1%. We divided the whole sample into two groups: children and adolescents with OCD and UHR symptoms (n = 22) and children and adolescents with OCD without UHR symptoms (n = 29). Our findings suggest that the group with OCD and UHR symptoms shows worse global, social, and role functioning than the group with OCD without UHR symptoms. No differences were found on the severity of obsessive⁻compulsive symptomatology, the number of psychiatric diagnoses associated, and the level of depressive symptoms. The presence of UHR symptoms in children and adolescents with OCD could cause significant functional impairment and should be considered in order to plan specific and targeted therapeutic interventions

A multi-element psychosocial intervention for early psychosis (GET UP PIANO TRIAL) conducted in a catchment area of 10 million inhabitants: study protocol for a pragmatic cluster randomized controlled trial

Multi-element interventions for first-episode psychosis (FEP) are promising, but have mostly been conducted in non-epidemiologically representative samples, thereby raising the risk of underestimating the complexities involved in treating FEP in 'real-world' services