Increased Occipital Gyrification and Development of Psychotic Disorders in Individuals With an At-Risk Mental State: A Multicenter Study

Abstract Previous structural magnetic resonance imaging studies of psychotic disorders have demonstrated volumetric alterations in subcortical (ie, the basal ganglia, thalamus) and temporolimbic structures, which are involved in high-order cognition and emotional regulation. However, it remains unclear whether individuals at high risk for psychotic disorders with minimal confounding effects of medication exhibit volumetric changes in these regions. This multicenter magnetic resonance imaging study assessed regional volumes of the thalamus, caudate, putamen, nucleus accumbens, globus pallidus, hippocampus, and amygdala, as well as lateral ventricular volume using FreeSurfer software in 107 individuals with an at-risk mental state (ARMS) (of whom 21 [19.6%] later developed psychosis during clinical follow-up [mean = 4.9 years, SD = 2.6 years]) and 104 age- and gender-matched healthy controls recruited at 4 different sites. ARMS individuals as a whole demonstrated significantly larger volumes for the left caudate and bilateral lateral ventricles as well as a smaller volume for the right accumbens compared with controls. In male subjects only, the left globus pallidus was significantly larger in ARMS individuals. The ARMS group was also characterized by left-greater-than-right asymmetries of the lateral ventricle and caudate nucleus. There was no significant difference in the regional volumes between ARMS groups with and without later psychosis onset. The present study suggested that significant volume expansion of the lateral ventricle, caudate, and globus pallidus, as well as volume reduction of the accumbens, in ARMS subjects, which could not be explained only by medication effects, might be related to general vulnerability to psychopathology.

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Individualised prediction of psychosis in individuals meeting at-risk mental state (ARMS) criteria: protocol for a systematic review of clinical prediction models

Diagnostic and Prognostic Research ◽

10.1186/s41512-019-0066-5 ◽

2019 ◽

Vol 3 (1) ◽

Author(s):

Laura J. Bonnett ◽

Filippo Varese ◽

Catrin Tudur Smith ◽

Allan Flores ◽

Alison R. Yung

Keyword(s):

At Risk ◽

Mental State ◽

Psychotic Disorders ◽

Prediction Models ◽

Assessment Tool ◽

External Validation ◽

Clinical Prediction ◽

Analysis Model ◽

Clinical Prediction Models ◽

At Risk Mental State

Abstract Background Psychotic disorders affect about 3% of the population worldwide and are associated with high personal, social and economic costs. They tend to have their first onset in adolescence. Increasing emphasis has been placed on early intervention to detect illness and minimise disability. In the late 1990s, criteria were developed to identify individuals at high risk for psychotic disorder. These are known as the at-risk mental state (ARMS) criteria. While ARMS individuals have a risk of psychosis much greater than the general population, most individuals meeting the ARMS criteria will not develop psychosis. Despite this, the National Institute for Health and Care Excellence recommends cognitive behavioural therapy (CBT) for all ARMS people. Clinical prediction models that combine multiple patient characteristics to predict individual outcome risk may facilitate identification of patients who would benefit from CBT and conversely those that would benefit from less costly and less intensive regular mental state monitoring. The study will systematically review the evidence on clinical prediction models aimed at making individualised predictions for the transition to psychosis. Methods Database searches will be conducted on PsycINFO, Medline, EMBASE and CINAHL. Reference lists and subject experts will be utilised. No language restrictions will be placed on publications, but searches will be restricted to 1994 onwards, the initial year of the first prospective study using ARMS criteria. Studies of any design will be included if they examined, in ARMS patients, whether more than one factor in combination is associated with the risk of transition to psychosis. Study quality will be assessed using the prediction model risk of bias assessment tool (PROBAST). Clinical prediction models will be summarised qualitatively, and if tested in multiple validation studies, their predictive performance will be summarised using a random-effects meta-analysis model. Discussion The results of the review will identify prediction models for the risk of transition to psychosis. These will be informative for clinicians currently treating ARMS patients and considering potential preventive interventions. The conclusions of the review will also inform the possible update and external validation of prediction models and clinical prediction rules to identify those at high or low risk of transition to psychosis. Trial registration The review has been registered with PROSPERO (CRD42018108488).

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Long-term validity of the At Risk Mental State (ARMS) for predicting psychotic and non-psychotic mental disorders

European Psychiatry ◽

10.1016/j.eurpsy.2016.11.010 ◽

2017 ◽

Vol 42 ◽

pp. 49-54 ◽

Cited By ~ 66

Author(s):

P. Fusar-Poli ◽

G. Rutigliano ◽

D. Stahl ◽

C. Davies ◽

A. De Micheli ◽

...

Keyword(s):

At Risk ◽

Mental Disorders ◽

Mental State ◽

Lower Risk ◽

Psychotic Disorders ◽

High Sensitivity ◽

Psychotic Symptoms ◽

Increased Risk ◽

At Risk Mental State

AbstractBackgroundThe long-term clinical validity of the At Risk Mental State (ARMS) for the prediction of non-psychotic mental disorders is unknown.MethodsClinical register-based cohort study including all non-psychotic individuals assessed by the Outreach And Support in South London (OASIS) service (2002–2015). The primary outcome was risk of developing any mental disorder (psychotic or non-psychotic). Analyses included Cox proportional hazard models, Kaplan–Meier survival/failure function and C statistics.ResultsA total of 710 subjects were included. A total of 411 subjects were at risk (ARMS+) and 299 not at risk (ARMS−). Relative to ARMS−, the ARMS+ was associated with an increased risk (HR = 4.825) of developing psychotic disorders, and a reduced risk (HR = 0.545) of developing non-psychotic disorders (mainly personality disorders). At 6-year, the ARMS designation retained high sensitivity (0.873) but only modest specificity (0.456) for the prediction of psychosis onset (AUC 0.68). The brief and limited intermittent psychotic symptoms (BLIPS) subgroup had a higher risk of developing psychosis, and a lower risk of developing non-psychotic disorders as compared to the attenuated psychotic symptoms (APS) subgroup (P < 0.001).ConclusionsIn the long-term, the ARMS specifically predicts the onset of psychotic disorders, with modest accuracy, but not of non-psychotic disorders. Individuals meeting BLIPS criteria have distinct clinical outcomes.Significant outcomesIn the long-term, the ARMS designation is still significantly associated with an increased risk of developing psychotic disorders but its prognostic accuracy is only modest. There is no evidence that the ARMS is associated with an increased risk of developing non-psychotic mental disorders. The BLIPS subgroup at lower risk of developing non-psychotic disorders compared to the APS subgroup.LimitationsWhile incident diagnoses employed in this study are high in ecological validity they have not been subjected to formal validation with research-based criteria.

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Neuroimaging and Treatment Evidence for Clinical Staging in Psychotic Disorders: From the At-Risk Mental State to Chronic Schizophrenia

Biological Psychiatry ◽

10.1016/j.biopsych.2011.05.034 ◽

2011 ◽

Vol 70 (7) ◽

pp. 619-625 ◽

Cited By ~ 67

Author(s):

Stephen J. Wood ◽

Alison R. Yung ◽

Patrick D. McGorry ◽

Christos Pantelis

Keyword(s):

At Risk ◽

Mental State ◽

Psychotic Disorders ◽

Chronic Schizophrenia ◽

Clinical Staging ◽

At Risk Mental State

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Features of Duration Mismatch Negativity Around the Onset of Overt Psychotic Disorders: A Longitudinal Study

Cerebral Cortex ◽

10.1093/cercor/bhaa364 ◽

2020 ◽

Author(s):

Takahiro Tateno ◽

Yuko Higuchi ◽

Suguru Nakajima ◽

Daiki Sasabayashi ◽

Mihoko Nakamura ◽

...

Keyword(s):

At Risk ◽

Mental State ◽

Mismatch Negativity ◽

Psychotic Disorders ◽

Transition Period ◽

Oddball Paradigm ◽

Auditory Oddball ◽

Not At Risk ◽

At Risk Mental State

Abstract Reduced amplitude of duration mismatch negativity (dMMN) has been reported in psychotic disorders and at-risk mental state (ARMS); however, few longitudinal MMN studies have examined the amplitude changes during the course of psychosis. We compared dMMN amplitude between ARMS individuals with later psychosis onset and those without, and we longitudinally examined potential dMMN changes around psychosis onset. Thirty-nine ARMS subjects and 22 healthy controls participated in this study. Of the 39 ARMS subjects, 11 transitioned to psychosis (at-risk mental state with later psychosis onset [ARMS-P]) during follow-up and 28 did not (at-risk mental state without later psychosis onset [ARMS-NP]). dMMN was measured twice using an auditory oddball paradigm with a mean interval of 2 years. Follow-up dMMN data were available for all but four ARMS-P subjects. dMMN amplitude at baseline was smaller in ARMS-P subjects compared with control and ARMS-NP subjects. Additionally, ARMS-P subjects displayed a longitudinal decline in dMMN amplitude, which was not present in control and ARMS-P subjects. We also observed a progressive decline in dMMN amplitude during the transition period, suggesting dynamic brain changes associated with the psychosis onset. Our findings implicate dMMN amplitude as a biological predictor of future psychosis onset in high-risk individuals, which may be used for early detection and intervention of psychosis.

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