Childhood maltreatment and transition to psychotic disorder independently predict long-term functioning in young people at ultra-high risk for psychosis

Background.Individuals identified as at ultra-high risk (UHR) for psychosis are at risk of poor functional outcome regardless of development of psychotic disorder. Studies examining longitudinal predictors of poor functioning have tended to be small and report only medium-term follow-up data. We sought to examine clinical predictors of functional outcome in a long-term longitudinal study.Method.Participants were 268 (152 females, 116 males) individuals identified as UHR 2–14 years previously. A range of clinical and sociodemographic variables were assessed at baseline. Functioning at follow-up was assessed using the Social and Occupational Functioning Assessment Scale (SOFAS).Results.Baseline negative symptoms, impaired emotional functioning, disorders of thought content, low functioning, past substance use disorder and history of childhood maltreatment predicted poor functioning at follow-up in univariate analyses. Only childhood maltreatment remained significant in the multivariate analysis (p < 0.001). Transition to psychosis was also significantly associated with poor functioning at long-term follow-up [mean SOFAS score 59.12 (s.d. = 18.54) in the transitioned group compared to 70.89 (s.d. = 14.00) in the non-transitioned group, p < 0.001]. Childhood maltreatment was a significant predictor of poor functioning in both the transitioned and non-transitioned groups.Conclusions.Childhood maltreatment and transition to psychotic disorder independently predicted poor long-term functioning. This suggests that it is important to assess history of childhood maltreatment in clinical management of UHR individuals. The finding that transition to psychosis predicts poor long-term functioning strengthens the evidence that the UHR criteria detect a subgroup at risk for schizophrenia.

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Intelligence trajectories in individuals at ultra-high risk for psychosis: An 8-year longitudinal analysis

10.31234/osf.io/45tpn ◽

2021 ◽

Author(s):

Nicholas Cheng ◽

Ashleigh Lin ◽

Stephen C. Bowden ◽

Caroline Gao ◽

Alison R. Yung ◽

...

Keyword(s):

High Risk ◽

Psychotic Disorder ◽

Fluid Intelligence ◽

Block Design ◽

Small Sample ◽

Linear Mixed Effects ◽

Ultra High Risk ◽

Matrix Reasoning

Background: Cognitive impairment is a well-documented predictor of transition to a full-threshold psychotic disorder amongst individuals at ultra-high risk (UHR) for psychosis. However, less is known about whether change in cognitive functioning differs between those who do and do not transition to a psychotic disorder. Studies to date have not examined trajectories in intelligence constructs (e.g., acquired knowledge and fluid intelligence), which have demonstrated marked impairments in individuals with schizophrenia. This study aimed to examine intelligence trajectories using longitudinal data from three time-points, spanning an average of eight years.Methods: Participants (N=139) at UHR for psychosis completed the Wechsler Abbreviated Scale of Intelligence (WASI) at each follow-up. Linear mixed-effects models mapped changes in WASI Full-Scale IQ (FSIQ) and T-scores on Vocabulary, Similarities, Block Design, and Matrix Reasoning subtests.Results: The sample showed stable and improving trajectories for FSIQ and all subtests. There were no significant differences in trajectories between those who did and did not transition to psychosis and between individuals with good and poor functional outcomes. However, although not significant, the trajectories of the acquired knowledge subtests diverged between transitioned and non-transitioned individuals (β=−0.12, 95% CI [−0.29, 0.05] for Vocabulary and β=−0.14, 95% CI [−0.33, 0.05] for Similarities). Conclusions: There was no evidence for long-term deterioration in intelligence trajectories in this UHR sample. As the small sample of individuals who transitioned may have limited our ability to detect subtle differences, future studies with larger sample sizes are needed to explore potential differences in intelligence trajectories between UHR transition groups.

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Poster #T223 AXIS I AND AXIS II DISORDERS IN YOUNG PEOPLE AT ULTRA-HIGH RISK OF DEVELOPING A PSYCHOTIC DISORDER: A LONG-TERM FOLLOW UP STUDY

Schizophrenia Research ◽

10.1016/s0920-9964(14)71039-4 ◽

2014 ◽

Vol 153 ◽

pp. S368-S369

Author(s):

Anneliese E. Spiteri-Staines ◽

Alison R. Yung ◽

Paul G. Amminger ◽

Stephen Wood ◽

Ashleigh Lin ◽

...

Keyword(s):

High Risk ◽

Young People ◽

Psychotic Disorder ◽

Axis Ii ◽

Follow Up Study ◽

Ultra High Risk ◽

Long Term Follow Up ◽

Axis I

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Dementia screening in elderly high-risk patients following heart failure decompensation may predict unfavorable long-term clinical outcomes

European Heart Journal ◽

10.1093/ehjci/ehaa946.0979 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

K Stepien ◽

P Furczynska ◽

M Zalewska ◽

K Nowak ◽

A Wlodarczyk ◽

...

Keyword(s):

Heart Failure ◽

High Risk ◽

Clinical Outcomes ◽

Mmse Score ◽

Coronary Revascularization ◽

High Risk Population ◽

Risk Population ◽

History Of

Abstract Background Recently heart failure (HF) has been found to be a new dementia risk factor, nevertheless their relations in patients following HF decompensation remain unknown. Purpose We sought to investigate whether a screening diagnosis for dementia (SDD) in this high-risk population may predict unfavorable long-term clinical outcomes. Methods 142 patients following HF decompensation requiring hospitalization were enrolled. Within a median time of 55 months all patients were screened for dementia with ALFI-MMSE scale whereas their compliance was assessed with the Morisky Medication Adherence Scale. Any incidents of myocardial infarction, coronary revascularization, stroke or transient ischemic attack (TIA), revascularization, HF hospitalization and bleedings during follow-up were collected. Results SDD was established in 37 patients (26%) based on the result of an ALFI-MMSE score of <17 points. By multivariate analysis the lower results of the ALFI-MMSE score were associated with a history of stroke/TIA (β=−0.29, P<0.001), peripheral arterial disease (PAD) (β=−0.20, P=0.011) and lower glomerular filtration rate (β=0.24, P=0.009). During the follow-up, patients with SDD were more often rehospitalized following HF decompensation (48.7% vs 28.6%, P=0.014) than patients without SDD, despite a similar level of compliance (P=0.25). Irrespective of stroke/TIA history, SDD independently increased the risk of rehospitalization due to HF decompensation (HR 2.22, 95% CI 1.23–4.01, P=0.007). Conclusions As shown for the first time in literature patients following decompensated HF, a history of stroke/TIA, PAD and impaired renal function independently influenced SDD. In this high-risk population, SDD was not associated with patients' compliance but irrespective of the stroke/TIA history it increased the risk of recurrent HF hospitalization. The survival free of rehospitalization Funding Acknowledgement Type of funding source: None

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History of Childhood Physical Trauma Has a Negative Impact On Cognitive Functioning in Individuals at Ultra High Risk for Psychosis

European Psychiatry ◽

10.1016/s0924-9338(15)31297-9 ◽

2015 ◽

Vol 30 ◽

pp. 1691

Author(s):

A. Ucok ◽

U. Cikrikçili ◽

H. Kaya ◽

O. Bulbul ◽

C. Yokusoglu ◽

...

Keyword(s):

High Risk ◽

Cognitive Functioning ◽

Negative Impact ◽

History Of Childhood ◽

Physical Trauma ◽

Ultra High Risk ◽

History Of

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Childhood trauma and being at-risk for psychosis are associated with higher peripheral endocannabinoids

Psychological Medicine ◽

10.1017/s0033291719001946 ◽

2019 ◽

Vol 50 (11) ◽

pp. 1862-1871 ◽

Cited By ~ 2

Author(s):

E. Appiah-Kusi ◽

R. Wilson ◽

M. Colizzi ◽

E. Foglia ◽

E. Klamerus ◽

...

Keyword(s):

Risk Factors ◽

At Risk ◽

Childhood Trauma ◽

Childhood Maltreatment ◽

Peripheral Blood ◽

Endocannabinoid System ◽

History Of Childhood ◽

Increased Risk ◽

History Of

AbstractBackgroundEvidence has been accumulating regarding alterations in components of the endocannabinoid system in patients with psychosis. Of all the putative risk factors associated with psychosis, being at clinical high-risk for psychosis (CHR) has the strongest association with the onset of psychosis, and exposure to childhood trauma has been linked to an increased risk of development of psychotic disorder. We aimed to investigate whether being at-risk for psychosis and exposure to childhood trauma were associated with altered endocannabinoid levels.MethodWe compared 33 CHR participants with 58 healthy controls (HC) and collected information about previous exposure to childhood trauma as well as plasma samples to analyse endocannabinoid levels.ResultsIndividuals with both CHR and experience of childhood trauma had higher N-palmitoylethanolamine (p < 0.001) and anandamide (p < 0.001) levels in peripheral blood compared to HC and those with no childhood trauma. There was also a significant correlation between N-palmitoylethanolamine levels and symptoms as well as childhood trauma.ConclusionsOur results suggest an association between CHR and/or childhood maltreatment and elevated endocannabinoid levels in peripheral blood, with a greater alteration in those with both CHR status and history of childhood maltreatment compared to those with either of those risks alone. Furthermore, endocannabinoid levels increased linearly with the number of risk factors and elevated endocannabinoid levels correlated with the severity of CHR symptoms and extent of childhood maltreatment. Further studies in larger cohorts, employing longitudinal designs are needed to confirm these findings and delineate the precise role of endocannabinoid alterations in the pathophysiology of psychosis.

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

Psychological Medicine ◽

10.1017/s003329171900299x ◽

2019 ◽

pp. 1-7 ◽

Cited By ~ 6

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.

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