scholarly journals Prevalence and clinical relevance of interview-assessed psychosis-risk symptoms in the young adult community

2017 ◽  
Vol 48 (7) ◽  
pp. 1167-1178 ◽  
Author(s):  
Frauke Schultze-Lutter ◽  
Chantal Michel ◽  
Stephan Ruhrmann ◽  
Benno G. Schimmelmann
Keyword(s):  
Risk Factors ◽  
Young Adult ◽  
High Risk ◽  
Clinical Relevance ◽  
Community Sample ◽  
Clinical Samples ◽  
Basic Symptoms ◽  
Risk Criteria ◽  
Psychosis Risk ◽  
Ultra High Risk

AbstractBackgroundAn efficient indicated prevention of psychotic disorders requires valid risk criteria that work in both clinical and community samples. Yet, ultra-high risk and basic symptom criteria were recently recommended for use in clinical samples only. Their use in the community was discouraged for lack of knowledge about their prevalence, clinical relevance and risk factors in non-clinical, community settings when validly assessed with the same instruments used in the clinic.MethodsUsing semi-structured telephone interviews with established psychosis-risk instruments, we studied the prevalence of psychosis-risk symptoms and criteria, their clinical relevance (using presence of a non-psychotic mental disorder or of functional deficits as proxy measures) and their risk factors in a random, representative young adult community sample (N=2683; age 16–40 years; response rate: 63.4%).ResultsThe point-prevalence of psychosis-risk symptoms was 13.8%. As these mostly occurred too infrequent to meet frequency requirements of psychosis-risk criteria, only 2.4% of participants met psychosis-risk criteria. A stepwise relationship underlay the association of ultra-high risk and basic symptoms with proxy measures of clinical relevance, this being most significant when both occurred together. In line with models of their formation, basic symptoms were selectively associated with age, ultra-high risk symptoms with traumatic events and lifetime substance misuse.ConclusionsPsychosis-risk criteria were uncommon, indicating little risk of falsely labelling individuals from the community at-risk for psychosis. Besides, both psychosis-risk symptoms and criteria seem to possess sufficient clinical relevance to warrant their broader attention in clinical practice, especially if ultra-high risk and basic symptoms occur together.

Clinical High Risk Symptoms and Criteria in the Community: Prevalence, Clinical Significance and Risk Factors for Their Occurrence

2017 ◽  
Vol 41 (S1) ◽  
pp. S226-S226
Author(s):  
F. Schultze-Lutter ◽  
C. Michel ◽  
B.G. Schimmelmann ◽  
S. Ruhrmann
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Clinical Relevance ◽  
Clinical Samples ◽  
Clinical High Risk ◽  
Basic Symptoms ◽  
Developmental Models ◽  
Increased Risk ◽  
Ultra High Risk ◽  
Competing Interest

IntroductionIn clinical samples, symptomatic ultra-high risk (UHR) criteria and the basic symptom criterion “cognitive disturbances” perform well in predicting psychosis, and best when both approaches are combined.ObjectiveHowever, little-to-nothing is known about clinical high risk (CHR) and their constituent symptoms in the community.AimsWe studied the prevalence, clinical relevance, and moderators of CHR criteria and symptoms in the community.MethodRegression analyses involved 2683 community participants (age 16–40 years; response rate: 63.4%). Semi-structured telephone interviews were performed by well-trained psychologists.ResultsLifetime and current CHR symptoms were reported by 21.1% and 13.8% of interviewees. Frequency of symptoms was mostly low, only 2.4% met any CHR criterion. A stepwise relationship underlay the association of the two types of CHR symptoms and criteria with the presence of mental disorders and functional deficits, with odds ratios being highest (7.4–31.8) when UHR and basic symptoms occurred together. Report of a family history of mental disorder generally increased risk for CHR symptoms. While younger age increased risk for basic symptoms, lifetime substance misuse and trauma increased risk for UHR symptoms.ConclusionsPrevalence of CHR criteria was within the to-be-expected range from prevalence rates of psychoses. Clinical relevance of both CHR symptoms and criteria increased in a stepwise manner from basic symptoms via UHR symptoms to their combined presence, reinforcing the clinical utility of their combined use. The risk factors selectively associated with basic and UHR symptoms support developmental models relating basic symptoms to neurobiological and UHR symptoms to psychological factors.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Improving the clinical prediction of psychosis by combining ultra-high risk criteria and cognitive basic symptoms

2014 ◽  
Vol 154 (1-3) ◽  
pp. 100-106 ◽  
Author(s):  
Frauke Schultze-Lutter ◽  
Joachim Klosterkötter ◽  
Stephan Ruhrmann
Keyword(s):  
High Risk ◽  
Clinical Prediction ◽  
Basic Symptoms ◽  
Risk Criteria ◽  
Ultra High Risk

scholarly journals Young people at ultra high risk for psychosis: research from the PACE clinic

2011 ◽  
Vol 33 (suppl 2) ◽  
pp. s143-s160 ◽  
Author(s):  
Alison R. Yung ◽  
Barnaby Nelson
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Psychotic Disorders ◽  
Omega 3 ◽  
Prodromal Phase ◽  
Risk Criteria ◽  
Current Controversy ◽  
Ultra High Risk ◽  
Risk Approach ◽  
Attenuated Psychosis Syndrome

Over the last fifteen years, attempts have been made to prospectively identify individuals in the prodromal phase of schizophrenia and other psychotic disorders. The ultra high risk approach, based on a combination of known trait and state risk factors, has been the main strategy used. The validation of the ultra high risk criteria allowed for predictive research in this population in an attempt to identify clinical, neurocognitive and neurobiological risk factors for psychosis onset. It also led to a series of intervention studies in this population, which have included the use of low dose antipsychotic medication, cognitive therapy, and omega-3 fatty acids. Although there is moderate evidence for the effectiveness of specific intervention strategies in this population, the most effective type and duration of intervention is yet to be determined. A current controversy in the field is whether to include an adaption of the ultra high risk criteria (the attenuated psychosis syndrome) in the next version of the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition).

scholarly journals Predicting the development of schizophrenia in high-risk populations: Systematic review of the predictive validity of prodromal criteria

2011 ◽  
Vol 199 (5) ◽  
pp. 361-366 ◽  
Author(s):  
Jefter Chuma ◽  
Prem Mahadun
Keyword(s):  
Systematic Review ◽  
High Risk ◽  
Sensitivity And Specificity ◽  
Predictive Validity ◽  
Evidence Base ◽  
Prodromal Stage ◽  
Basic Symptoms ◽  
Risk Criteria ◽  
Ultra High Risk ◽  
High Risk Populations

BackgroundThere is a great deal of debate on the usefulness and accuracy of prodromal criteria in predicting schizophrenia. The risk of treating people who screen false positive with medication is considerable. Yet intervening during the prodromal stage of illness may reduce the burden caused by schizophrenia.AimsTo draw together the evidence base for the predictive validity of prodromal criteria in identifying individuals at high risk of developing schizophrenia.MethodWe conducted a systematic review of prospective studies investigating the predictive validity of prodromal criteria in schizophrenia.ResultsOur study found two main criteria, ultra-high-risk criteria and basic-symptoms criteria, used in studies investigating the predictive validity of prodromal symptoms. The sensitivity and specificity of ultra-high-risk criteria was 0.81 (95% CI 0.76–0.85) and 0.67 (95% CI 0.64–0.70) respectively and for basic-symptoms criteria sensitivity and specificity was 0.97 (95% CI 0.91–1.00) and 0.59 (95% CI 0.48–0.70) respectively.ConclusionsBoth ultra-high-risk criteria and basic-symptoms criteria are useful in predicting the development of schizophrenia among high-risk populations.

scholarly journals SU50. Schizotypy Moderates the Effect of Basic Symptoms on Conversion to Overt Psychosis in Individuals at Ultra-High Risk for Psychosis

2017 ◽  
Vol 43 (suppl_1) ◽  
pp. S179-S179
Author(s):  
Minji Bang ◽  
Jin Young Park ◽  
Kyung Ran Kim ◽  
Su Young Lee ◽  
Yun Young Song ◽  
...  
Keyword(s):  
High Risk ◽  
Basic Symptoms ◽  
Ultra High Risk

scholarly journals Associations of psychosis-risk symptoms with quality of life and self-rated health in the Community

2019 ◽  
Vol 62 ◽  
pp. 116-123 ◽  
Author(s):  
Chantal Michel ◽  
Stefanie J. Schmidt ◽  
Nina Schnyder ◽  
Rahel Flückiger ◽  
Iljana Käufeler ◽  
...  
Keyword(s):  
Quality Of Life ◽  
High Risk ◽  
Anxiety Disorders ◽  
Basic Symptoms ◽  
Self Rated Health ◽  
Psychosis Risk ◽  
Axis I Disorders ◽  
Axis I ◽  
Lower Education

Abstract Background: Understanding factors related to poor quality of life (QoL) and self-rated health (SRH) in clinical high-risk (CHR) for psychosis is important for both research and clinical applications. We investigated the associations of both constructs with CHR symptoms, axis-I disorders, and sociodemographic variables in a community sample. Methods: In total, 2683 (baseline) and 829 (3-year follow-up) individuals of the Swiss Canton of Bern (age-at-baseline: 16–40 years) were interviewed by telephone regarding CHR symptoms, using the Schizophrenia Proneness Instrument for basic symptoms, the Structured Interview for Psychosis-Risk Syndromes for ultra-high risk (UHR) symptoms, the Mini-International Neuropsychiatric Interview for current axis-I disorders, the Brief Multidimensional Life Satisfaction Scale for QoL, and the 3-level EQ-5D for SRH. Results: In cross-sectional structural equation modelling, lower SRH was exclusively significantly associated with higher age, male gender, lower education, and somatoform disorders. Poor QoL was exclusively associated only with eating disorders. In addition, both strongly interrelated constructs were each associated with affective, and anxiety disorders, UHR and, more strongly, basic symptoms. Prospectively, lower SRH was predicted by lower education and anxiety disorders at baseline, while poorer QoL was predicted by affective disorders at baseline. Conclusions: When present, CHR, in particular basic symptoms are already distressful for individuals of the community and associated with poorer subjective QoL and health. Therefore, the symptoms are clinically relevant by themselves, even when criteria for a CHR state are not fulfilled. Yet, unlike affective and anxiety disorders, CHR symptoms seem to have no long-term influence on QoL and SRH.

Basic symptoms and gray matter volumes of patients at clinical high risk for psychosis

2020 ◽  
pp. 1-9 ◽  
Author(s):  
Daniela Hubl ◽  
Chantal Michel ◽  
Frauke Schultze-Lutter ◽  
Martinus Hauf ◽  
Benno G. Schimmelmann ◽  
...  
Keyword(s):  
High Risk ◽  
Gray Matter ◽  
First Episode ◽  
Clinical High Risk ◽  
Significant Group ◽  
Basic Symptoms ◽  
Conversion Rates ◽  
Episode Psychosis ◽  
Ultra High Risk ◽  
Gray Matter Volumes

Abstract Background Clinical high-risk (CHR) for psychosis is indicated by ultra-high risk (UHR) and basic symptom (BS) criteria; however, conversion rates are highest when both UHR and BS criteria are fulfilled (UHR&BS). While BSs are considered the most immediate expression of neurobiological aberrations underlying the development of psychosis, research on neurobiological correlates of BS is scarce. Methods We investigated gray matter volumes (GMV) of 20 regions of interest (ROI) previously associated with UHR criteria in 90 patients from the Bern early detection service: clinical controls (CC), first-episode psychosis (FEP), UHR, BS and UHR&BS. We expected lowest GMV in FEP and UHR&BS, and highest volume in CC with UHR and BS in-between. Results Significantly, lower GMV was detected in FEP and UHR&BS patients relative to CC with no other significant between-group differences. When ROIs were analyzed separately, seven showed a significant group effect (FDR corrected), with five (inferior parietal, medial orbitofrontal, lateral occipital, middle temporal, precuneus) showing significantly lower GM volume in the FEP and/or UHR&BS groups than in the CC group (Bonferroni corrected). In the CHR group, only COGDIS scores correlated negatively with cortical volumes. Conclusions This is the first study to demonstrate that patients who fulfill both UHR and BS criteria – a population that has been associated with higher conversion rates – exhibit more severe GMV reductions relative to those who satisfy BS or UHR criteria alone. This result was mediated by the BS in the UHR&BS group, as only the severity of BS was linked to GMV reductions.

scholarly journals Assessing Developmental Environmental Risk Factor Exposure in Clinical High Risk for Psychosis Individuals: Preliminary Results Using the Individual and Structural Exposure to Stress in Psychosis-Risk States Scale

2019 ◽  
Vol 8 (7) ◽  
pp. 994
Author(s):  
Teresa Vargas ◽  
Denise S. Zou ◽  
Rachel E. Conley ◽  
Vijay A. Mittal
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Environmental Risk ◽  
Statistical Significance ◽  
Environmental Risk Factors ◽  
Group Differences ◽  
Clinical High Risk ◽  
Significant Group ◽  
Psychosis Risk ◽  
Age Range

Introduction: Exposure to cumulative environmental risk factors across development has been linked to a host of adverse health/functional outcomes. This perspective incorporating information regarding exposure at differing developmental periods is lacking in research surrounding individuals at Clinical High Risk (CHR) for developing a psychotic disorder. Methods: CHR individuals (n = 35) and healthy volunteers (n = 28) completed structured clinical interviews as well as our group’s newly developed Individual and Structural Exposure to Stress in Psychosis-risk-states (ISESP) interview. Lifetime cumulative scores were calculated, and severity of stress was reported for multiple developmental periods/ages. Group differences were tested, and associations with current symptom domains were examined. Results: Significant group differences were not observed for lifetime cumulative events, though CHR trended toward endorsing more events and greater stress severity. For stress severity across development, there were trending group differences for the 11–13 age range, and significant group differences for the 14–18 age range; notably, comparisons for earlier time points did not approach statistical significance. Associations between negative symptoms and cumulative severity of exposure were observed. Discussion: Results suggest exploring exposure to cumulative environmental risk factors/stressors and stress severity across developmental periods is generally informative and possibly specifically so for predictive models and diathesis-stress psychosis risk conceptualizations.

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