Emotional and symptomatic reactivity to stress in individuals at ultra-high risk of developing psychosis

2011 ◽  
Vol 42 (5) ◽  
pp. 1003-1012 ◽  
Author(s):  
J. E. Palmier-Claus ◽  
G. Dunn ◽  
S. W. Lewis
Keyword(s):  
High Risk ◽  
Emotional Reactivity ◽  
Clinical Sample ◽  
Stressful Events ◽  
Psychotic Symptoms ◽  
Healthy Individuals ◽  
Multilevel Regression ◽  
Self Assessment ◽  
Ultra High Risk ◽  
And Gender

BackgroundThe stress–vulnerability model of psychosis continues to be influential. The aim of this study was to compare emotional and symptomatic responses to stress in individuals at ultra-high risk (UHR) of developing psychosis, in age- and gender-matched healthy controls, and in patients with non-affective psychosis.MethodA total of 27 UHR, 27 psychotic and 27 healthy individuals completed the experience sampling method, an ambulant diary technique, where they were required to fill in self-assessment questions about their emotions, symptoms and perceived stress at semi-random times of the day for 6 days. Quesionnaire and interview assessments were also completed.ResultsMultilevel regression analyses showed that individuals at UHR of developing psychosis reported greater negative emotions in response to stress than the healthy individuals. Against the initial hypotheses, the UHR individuals also experienced greater emotional reactivity to stress when compared with the patient group. No significant differences were observed between the patients and the non-clinical sample. Stress measures significantly predicted the intensity of psychotic symptoms in UHR individuals and patients, but the extent of this did not significantly differ between the groups.ConclusionsIndividuals at UHR of developing psychosis may be particularly sensitive to everyday stressors. This effect may diminish after transition to psychosis is made and in periods of stability. Subtle increases in psychotic phenomena occur in response to stressful events across the continuum of psychosis.

scholarly journals Development of Executive Functions as Reflected in Daily Life Behaviors in Young Adults at Ultra-High Risk for Psychosis: Associations With Symptoms and Functioning

2020 ◽  
Vol 1 (1) ◽  
Author(s):  
Louise Birkedal Glenthøj ◽  
Carsten Hjorthøj ◽  
Tina Dam Kristensen ◽  
Christina Wenneberg ◽  
Merete Nordentoft ◽  
...  
Keyword(s):  
High Risk ◽  
Executive Functions ◽  
Social Functioning ◽  
Clinical Symptoms ◽  
Daily Life ◽  
Real Life ◽  
Psychotic Symptoms ◽  
Ultra High Risk ◽  
Behaviour Rating

Abstract There is a paucity of evidence on executive functions (EF) as reflected in daily life behaviors in individuals at ultra-high risk (UHR) for psychosis. This prospective follow-up study investigated the 1-year development in EF in UHR compared to healthy controls (HC) and how this change may relate to change in severity of clinical symptoms, social communication, and functioning. UHR (N = 132) and HC (N = 66) were assessed with the Behaviour Rating Inventory of Executive Function–Adult version (BRIEF-A) self and informant report at baseline and 12 months follow-up comprising the Behavioral Regulation Index (BRI) and the Metacognition Index (MI). Additionally, data on depressive-, negative-, and attenuated psychotic symptoms and everyday social functioning were collected. The study found UHR to display large baseline impairments in EF in real life on both self- and informant reports. UHR and HC showed a significantly different development of EF over time, with UHR displaying greater improvements in EF compared to HC. Change in clinical symptoms did not relate to improvements in EF, except for depressive symptoms negatively associating with the development of the MI. Improvements on the BRI and MI were significantly associated with improvements in social functioning. Findings suggest the potential of UHR individuals displaying a larger ongoing maturational development of daily life EF than HC that seems predominantly independent of development of clinical symptoms. If replicated, this supports a maturational trajectory of daily life EF in UHR that approaches, but do not reach, the level of HC and may indicate a window of opportunity for targeted remediation approaches.

scholarly journals The reality of at risk mental state services: a response to recent criticisms

2019 ◽  
pp. 1-7 ◽  
Author(s):  
Alison R. Yung ◽  
Stephen J. Wood ◽  
Ashok Malla ◽  
Barnaby Nelson ◽  
Patrick McGorry ◽  
...  
Keyword(s):  
At Risk ◽  
High Risk ◽  
Psychotic Disorder ◽  
Mental State ◽  
Help Seeking ◽  
Psychotic Symptoms ◽  
Ultra High Risk ◽  
Psychological Medicine ◽  
Poor Outcomes ◽  
At Risk Mental State

AbstractBackgroundIn the 1990s criteria were developed to detect individuals at high and imminent risk of developing a psychotic disorder. These are known as the at risk mental state, ultra high risk or clinical high risk criteria. Individuals meeting these criteria are symptomatic and help-seeking. Services for such individuals are now found worldwide. Recently Psychological Medicine published two articles that criticise these services and suggest that they should be dismantled or restructured. One paper also provides recommendations on how ARMS services should be operate.MethodsIn this paper we draw on the existing literature in the field and present the perspective of some ARMS clinicians and researchers.ResultsMany of the critics' arguments are refuted. Most of the recommendations included in the Moritz et al. paper are already occurring.ConclusionsARMS services provide management of current problems, treatment to reduce risk of onset of psychotic disorder and monitoring of mental state, including attenuated psychotic symptoms. These symptoms are associated with a range of poor outcomes. It is important to assess them and track their trajectory over time. A new approach to detection of ARMS individuals can be considered that harnesses broad youth mental health services, such as headspace in Australia, Jigsaw in Ireland and ACCESS Open Minds in Canada. Attention should also be paid to the physical health of ARMS individuals. Far from needing to be dismantled we feel that the ARMS approach has much to offer to improve the health of young people.

Testing the Ultra High Risk (prodromal) criteria for the prediction of psychosis in a clinical sample of young people

2006 ◽  
Vol 84 (1) ◽  
pp. 57-66 ◽  
Author(s):  
Alison R. Yung ◽  
Carrie Stanford ◽  
Elizabeth Cosgrave ◽  
Eoin Killackey ◽  
Lisa Phillips ◽  
...  
Keyword(s):  
High Risk ◽  
Young People ◽  
Clinical Sample ◽  
Ultra High Risk

Früherkennung von Psychosen bei Kindern und Adoleszenten

2011 ◽  
Vol 39 (5) ◽  
pp. 301-312 ◽  
Author(s):  
Frauke Schultze-Lutter ◽  
Franz Resch ◽  
Eginhard Koch ◽  
Benno G. Schimmelmann
Keyword(s):  
High Risk ◽  
Kinder Und Jugendliche ◽  
Psychotic Symptoms ◽  
Dsm 5 ◽  
Ultra High Risk ◽  
Psychotische Symptome

Die Früherkennung und Frühbehandlung von Personen mit erhöhtem Psychoserisiko gilt derzeit als vielversprechende Strategie, die weitreichenden negativen Konsequenzen psychotischer Störungen zu reduzieren. Die beiden derzeitigen Risikokriteriensätze, die «ultra-high risk» und die Basissymptom-Kriterien, wurden vorwiegend an Erwachsenenstichproben entwickelt. Erste Studien sprechen dafür, dass diese Kriterien nur eingeschränkt auf Kinder und Jugendliche übertragbar sein könnten. Für die «ultra-high risk»-Kriterien gibt es Hinweise, dass einige attenuierte psychotische Symptome im Jugendalter möglicherweise nicht ausreichend spezifisch und, wenn beobachtbare Verhaltenskorrelate fehlen, kurze intermittierende psychotische Symptome im Kindesalter schwer klassifizierbar sind. Auch für die Basissymptom-Kriterien liegen nur sehr vorläufige Hinweise auf ihre Eignung bei Kindern und Adoleszenten vor. Da entwicklungsbezogene Besonderheiten auch bei der Erhebung von Basissymptomen berücksichtigt werden sollten, wurde eine Kinder- und Jugendversion des Schizophrenia Proneness Instrument (SPI-CY) entwickelt, die in der vorgelegten Arbeit vorgestellt wird. Somit sind gezielte Studien zur Validierung und ggf. Adaptation der Risikokriterien für Kinder und Jugendliche dringend erforderlich, insbesondere wenn ein «Prodromal Risk Syndrome for Psychosis» oder «Attenuated Psychotic Symptoms Syndrome» in das DSM-5 aufgenommen wird. In diesem Fall müsste betont werden, dass die klinisch-prognostische Validität dieses Risikosyndroms für Kinder und Jugendliche noch unzureichend geklärt ist.

scholarly journals Formal thought disorder in people at ultra-high risk of psychosis

BJPsych Open ◽  
2017 ◽  
Vol 3 (4) ◽  
pp. 165-170 ◽  
Author(s):  
Arsime Demjaha ◽  
Sara Weinstein ◽  
Daniel Stahl ◽  
Fern Day ◽  
Lucia Valmaggia ◽  
...  
Keyword(s):  
High Risk ◽  
First Episode Psychosis ◽  
High Risk Group ◽  
Thought Disorder ◽  
Psychotic Symptoms ◽  
First Episode ◽  
Control Group ◽  
Formal Thought Disorder ◽  
Episode Psychosis ◽  
Ultra High Risk

BackgroundFormal thought disorder is a cardinal feature of psychosis. However, the extent to which formal thought disorder is evident in ultra-high-risk individuals and whether it is linked to the progression to psychosis remains unclear.AimsExamine the severity of formal thought disorder in ultra-high-risk participants and its association with future psychosis.MethodThe Thought and Language Index (TLI) was used to assess 24 ultra-high-risk participants, 16 people with first-episode psychosis and 13 healthy controls. Ultra-high-risk individuals were followed up for a mean duration of 7 years (s.d.=1.5) to determine the relationship between formal thought disorder at baseline and transition to psychosis.ResultsTLI scores were significantly greater in the ultra-high-risk group compared with the healthy control group (effect size (ES)=1.2), but lower than in people with first-episode psychosis (ES=0.8). Total and negative TLI scores were higher in ultra-high-risk individuals who developed psychosis, but this was not significant. Combining negative TLI scores with attenuated psychotic symptoms and basic symptoms predicted transition to psychosis (P=0.04; ES=1.04).ConclusionsTLI is beneficial in evaluating formal thought disorder in ultra-high-risk participants, and complements existing instruments for the evaluation of psychopathology in this group.

Development of a stage-dependent prognostic model to predict psychosis in ultra-high-risk patients seeking treatment for co-morbid psychiatric disorders

2016 ◽  
Vol 46 (9) ◽  
pp. 1839-1851 ◽  
Author(s):  
H. K. Ising ◽  
S. Ruhrmann ◽  
N. A. F. M. Burger ◽  
J. Rietdijk ◽  
S. Dragt ◽  
...  
Keyword(s):  
High Risk ◽  
Social Functioning ◽  
Prognostic Model ◽  
Prognostic Index ◽  
First Episode Psychosis ◽  
Psychotic Symptoms ◽  
First Episode ◽  
Risk Class ◽  
Episode Psychosis ◽  
Ultra High Risk

BackgroundCurrent ultra-high-risk (UHR) criteria appear insufficient to predict imminent onset of first-episode psychosis, as a meta-analysis showed that about 20% of patients have a psychotic outcome after 2 years. Therefore, we aimed to develop a stage-dependent predictive model in UHR individuals who were seeking help for co-morbid disorders.MethodBaseline data on symptomatology, and environmental and psychological factors of 185 UHR patients (aged 14–35 years) participating in the Dutch Early Detection and Intervention Evaluation study were analysed with Cox proportional hazard analyses.ResultsAt 18 months, the overall transition rate was 17.3%. The final predictor model included five variables: observed blunted affect [hazard ratio (HR) 3.39, 95% confidence interval (CI) 1.56–7.35, p < 0.001], subjective complaints of impaired motor function (HR 5.88, 95% CI 1.21–6.10, p = 0.02), beliefs about social marginalization (HR 2.76, 95% CI 1.14–6.72, p = 0.03), decline in social functioning (HR 1.10, 95% CI 1.01–1.17, p = 0.03), and distress associated with suspiciousness (HR 1.02, 95% CI 1.00–1.03, p = 0.01). The positive predictive value of the model was 80.0%. The resulting prognostic index stratified the general risk into three risk classes with significantly different survival curves. In the highest risk class, transition to psychosis emerged on average ⩾8 months earlier than in the lowest risk class.ConclusionsPredicting a first-episode psychosis in help-seeking UHR patients was improved using a stage-dependent prognostic model including negative psychotic symptoms (observed flattened affect, subjective impaired motor functioning), impaired social functioning and distress associated with suspiciousness. Treatment intensity may be stratified and personalized using the risk stratification.

Sign in / Sign up

Export Citation Format

Share Document