M29. SPECIFIC SYMPTOMS IN ADOLESCENCE PREDICT PSYCHOSIS IN THE NORTHERN FINLAND BIRTH COHORT 1986

Abstract Background A number of psychological symptoms have been found to predict psychosis. Many studies have found no specificity to separate symptoms predicting non-psychotic psychiatric disorders from those predicting psychotic disorders. Prodromal symptoms are non-specific problems often preceding frank psychosis. Previously prodromal symptoms have been studied mainly retrospectively or in high-risk clinical populations. We were able to conduct prospective study comparing adolescent symptoms predicting non-psychotic psychiatric disorders and psychotic psychiatric disorders. Methods Members of the Northern Finland Birth Cohort 1986 were asked to fill in PROD-screen questionnaire at age 15–16 years. PROD-screen includes 21 items both measuring positive prodromal symptoms, negative prodromal symptoms and general symptoms. We were able to follow 5,368 participants using Finnish Hospital Discharge Register detecting new hospital treated mental disorders till 30 years. Results Subjects who developed psychosis had significantly more commonly positive and negative symptoms than subjects without psychiatric disorder or subjects who developed non-psychotic disorder. When comparing separate symptoms in those having psychiatric hospital treatments, we found three positive symptoms and three negative symptoms predicting specifically psychotic disorders. After adjusting for confounders, the symptoms predicting psychosis were: Difficulty in controlling one’s speech, behavior or facial expression while communicating, Difficulties in understanding written text or speech heard, Feelings, thoughts or behaviors that could be considered weird or peculiar. Three of the negative symptoms also predicted psychosis: Difficulty or uncertainty in making contact with other people, Lack of initiative or difficulty in completing tasks, Difficulties in carrying out ordinary routine activities (at least one week). Discussion In this large prospective population sample both positive and negative symptoms in adolescence associated specifically with development of first episode psychosis compared to hospital treated non-psychotic disorders. This finding is in line with the other prospective general population follow-up studies. The main contribution of our study to the literature is that we had the possibility to compare the subjects who developed clinically real hospital-treated psychosis not only to healthy comparison subjects but also to subjects who developed non-psychotic psychiatric disorder.

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Conceptual disorganization and redistribution of resting state cortical hubs in untreated first episode psychosis: A 7T MRI study

10.31234/osf.io/rzvby ◽

2020 ◽

Author(s):

Avyarthana Dey ◽

Kara Dempster ◽

Michael Mackinley ◽

Peter Jeon ◽

Tushar Das ◽

...

Keyword(s):

Negative Symptoms ◽

Superior Temporal Gyrus ◽

Brain Regions ◽

First Episode Psychosis ◽

Cortical Reorganization ◽

First Episode ◽

Formal Thought Disorder ◽

Whole Brain ◽

Episode Psychosis ◽

Positive And Negative Symptoms

Background:Network level dysconnectivity has been studied in positive and negative symptoms of schizophrenia. Conceptual disorganization (CD) is a symptom subtype which predicts impaired real-world functioning in psychosis. Systematic reviews have reported aberrant connectivity in formal thought disorder, a construct related to CD. However, no studies have investigated whole-brain functional correlates of CD in psychosis. We sought to investigate brain regions explaining the severity of CD in patients with first-episode psychosis (FEPs) compared with healthy controls (HCs).Methods:We computed whole-brain binarized degree centrality maps of 31 FEPs, 25 HCs and characterized the patterns of network connectivity in the two groups. In FEPs, we related these findings to the severity of CD. We also studied the effect of positive and negative symptoms on altered network connectivity.Results:Compared to HCs, reduced hubness of a right superior temporal gyrus (rSTG) cluster was observed in the FEPs. In patients exhibiting high CD, increased hubness of a medial superior parietal (mSPL) cluster was observed, compared to patients exhibiting low CD. These two regions were strongly correlated with CD scores but not with other symptom scores.Discussion:Our observations are congruent with previous findings of reduced but not increased hubness. We observed increased hubness of mSPL suggesting that cortical reorganization occurs to provide alternate routes for information transfer.Conclusion:These findings provide insight into the underlying neural processes mediating the presentation of symptoms in untreated FEP. A longitudinal tracking of the symptom course will be useful to assess the mechanisms underlying these compensatory changes.

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The effect of the environment on symptom dimensions in the first episode of psychosis: a multilevel study

Psychological Medicine ◽

10.1017/s0033291713003188 ◽

2014 ◽

Vol 44 (11) ◽

pp. 2419-2430 ◽

Cited By ~ 17

Author(s):

F. J. Oher ◽

A. Demjaha ◽

D. Jackson ◽

C. Morgan ◽

P. Dazzan ◽

...

Keyword(s):

Depressive Symptoms ◽

Population Density ◽

Negative Symptoms ◽

Psychotic Disorders ◽

Urban Environments ◽

Psychotic Symptoms ◽

First Episode ◽

Multilevel Regression ◽

Symptom Dimensions ◽

Reality Distortion

BackgroundThe extent to which different symptom dimensions vary according to epidemiological factors associated with categorical definitions of first-episode psychosis (FEP) is unknown. We hypothesized that positive psychotic symptoms, including paranoid delusions and depressive symptoms, would be more prominent in more urban environments.MethodWe collected clinical and epidemiological data on 469 people with FEP (ICD-10 F10–F33) in two centres of the Aetiology and Ethnicity in Schizophrenia and Other Psychoses (AESOP) study: Southeast London and Nottinghamshire. We used multilevel regression models to examine neighbourhood-level and between-centre differences in five symptom dimensions (reality distortion, negative symptoms, manic symptoms, depressive symptoms and disorganization) underpinning Schedules for Clinical Assessment in Neuropsychiatry (SCAN) Item Group Checklist (IGC) symptoms. Delusions of persecution and reference, along with other individual IGC symptoms, were inspected for area-level variation.ResultsReality distortion [estimated effect size (EES) 0.15, 95% confidence interval (CI) 0.06–0.24] and depressive symptoms (EES 0.21, 95% CI 0.07–0.34) were elevated in people with FEP living in more urban Southeast London but disorganized symptomatology was lower (EES –0.06, 95% CI –0.10 to –0.02), after controlling for confounders. Delusions of persecution were not associated with increased neighbourhood population density [adjusted odds ratio (aOR) 1.01, 95% CI 0.83–1.23], although an effect was observed for delusions of reference (aOR 1.41, 95% CI 1.12–1.77). Hallucinatory symptoms showed consistent elevation in more densely populated neighbourhoods (aOR 1.32, 95% CI 1.09–1.61).ConclusionsIn people experiencing FEP, elevated levels of reality distortion and depressive symptoms were observed in more urban, densely populated neighbourhoods. No clear association was observed for paranoid delusions; hallucinations were consistently associated with increased population density. These results suggest that urban environments may affect the syndromal presentation of psychotic disorders.

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Adolescent cannabis use, baseline prodromal symptoms and the risk of psychosis

The British Journal of Psychiatry ◽

10.1192/bjp.2017.52 ◽

2018 ◽

Vol 212 (4) ◽

pp. 227-233 ◽

Cited By ~ 21

Author(s):

Antti Mustonen ◽

Solja Niemelä ◽

Tanja Nordström ◽

Graham K. Murray ◽

Pirjo Mäki ◽

...

Keyword(s):

Substance Use ◽

General Population ◽

Birth Cohort ◽

Psychotic Disorders ◽

Temporal Order ◽

Population Based ◽

Cannabis Use ◽

Prodromal Symptoms ◽

Increased Risk ◽

Icd 10

BackgroundThe association between cannabis use and the risk of psychosis has been studied extensively but the temporal order still remains controversial.AimsTo examine the association between cannabis use in adolescence and the risk of psychosis after adjustment for prodromal symptoms and other potential confounders.MethodThe sample (n = 6534) was composed of the prospective general population-based Northern Finland Birth Cohort of 1986. Information on prodromal symptoms of psychosis and cannabis use was collected using questionnaires at age 15–16 years. Participants were followed up for ICD-10 psychotic disorders until age 30 years using nationwide registers.ResultsThe risk of psychosis was elevated in individuals who had tried cannabis five times or more (hazard ratio, (HR) = 6.5, 95% CI 3.0–13.9). The association remained statistically significant even when adjusted for prodromal symptoms, other substance use and parental psychosis (HR = 3.0, 95% CI 1.1–8.0).ConclusionsAdolescent cannabis use is associated with increased risk of psychosis even after adjustment for baseline prodromal symptoms, parental psychosis and other substance use.Declaration of interestNone.

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Predictors of outcome in first-episode schizophrenia over the first 4 years of illness

Psychological Medicine ◽

10.1017/s003329170800336x ◽

2008 ◽

Vol 38 (8) ◽

pp. 1141-1146 ◽

Cited By ~ 26

Author(s):

P. Whitty ◽

M. Clarke ◽

O. McTigue ◽

S. Browne ◽

M. Kamali ◽

...

Keyword(s):

Negative Symptoms ◽

First Episode ◽

Global Assessment Of Functioning ◽

Methodological Issues ◽

Course Of Illness ◽

Dsm Iv ◽

First Episode Schizophrenia ◽

The Relationship ◽

Positive And Negative Symptoms

BackgroundThe outcome of schizophrenia appears to be more favourable than once thought. However, methodological issues, including the reliance on diagnosis at first presentation have limited the validity of outcome studies to date.MethodWe conducted a first-episode follow-up study of 97 patients with DSM-IV schizophrenia over the first 4 years of illness. First presentation and follow-up assessments were compared using paired t tests and a forced-entry regression analysis was used to determine prognostic variables.ResultsThere were significant improvements in positive and negative symptoms and global assessment of functioning between first presentation and follow-up. At first presentation, fewer negative symptoms (t=−3.40, p<0.01), more years spent in education (t=3.25, p<0.01), and a shorter duration of untreated psychosis (DUP) (t=−2.77, p<0.01) significantly predicted a better outcome at follow-up.ConclusionsThe outcome of schizophrenia may not be as pessimistic as once thought and most patients did not display a downward deteriorating course of illness. This study supports the relationship between DUP and outcome beyond the early stages of illness.

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‘Soother of mind’ – meditation in psychiatric disorders: a narrative review

BJPsych Advances ◽

10.1192/bja.2021.51 ◽

2021 ◽

pp. 1-7

Author(s):

Vinod Kumar ◽

Shree Raksha Bhide ◽

Rashmi Arasappa ◽

Shivarama Varambally ◽

Bangalore N. Gangadhar

Keyword(s):

Psychiatric Disorders ◽

Negative Symptoms ◽

Psychotic Disorders ◽

Psychotic Symptoms ◽

Complete Absorption ◽

Psychiatric Conditions ◽

Biological Aspects ◽

The Mind ◽

Anxiety Depression ◽

Meditative Practices

SUMMARY Meditation, a component of ashtanga yoga, is an act of inward contemplation in which the mind fluctuates between a state of attention to a stimulus and complete absorption in it. Some forms of meditation have been found to be useful for people with psychiatric conditions such as anxiety, depression and substance use disorder. Evidence for usefulness of meditation for people with psychotic disorders is mixed, with reported improvements in negative symptoms but the emergence/precipitation of psychotic symptoms. This article narrates the benefits of meditation in psychiatric disorders, understanding meditation from the yoga perspective, biological aspects of meditation and practical tips for the practice of meditation. We also explain possible ways of modifying meditative practices to make them safe and useful for the patient population and useful overall as a society-level intervention.

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Schizophrenia: a conceptual history

New Oxford Textbook of Psychiatry ◽

10.1093/med/9780199696758.003.0071 ◽

2012 ◽

pp. 521-526

Author(s):

Nancy C. Andreasen

Keyword(s):

Diagnostic Criteria ◽

Negative Symptoms ◽

Psychotic Disorders ◽

King Lear ◽

Clinical Perspective ◽

Conceptual History ◽

Founding Fathers ◽

Future Developments ◽

Positive And Negative Symptoms

We know that psychotic disorders have been present and publicly recognized at least since classical times because of their portrayals in literature: the madness of Medea, the frenzied behaviour in The Bacchae, or the paranoia of Othello. Perhaps the most ‘valid’ portrayal from a modern clinical perspective is the feigned madness of ‘Poor Tom’ in King Lear. However, the definition and delineation of schizophrenia as a discrete disorder is a relatively recent phenomenon. This chapter covers the founding fathers of the concept: Kraepelin and Bleuler, Schneiderian symptoms, psychosis, and the dominance of diagnostic criteria, and the concept of positive and negative symptoms, finishing with a look present and future developments.

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Gender differences of patients at-risk for psychosis regarding symptomatology, drug use, comorbidity and functioning – Results from the EU-GEI study

European Psychiatry ◽

10.1016/j.eurpsy.2019.04.007 ◽

2019 ◽

Vol 59 ◽

pp. 52-59 ◽

Cited By ~ 5

Author(s):

Stephanie Menghini-Müller ◽

Erich Studerus ◽

Sarah Ittig ◽

Ulrike Heitz ◽

Laura Egloff ◽

...

Keyword(s):

Gender Differences ◽

At Risk ◽

Drug Use ◽

Anxiety Disorders ◽

Statistical Power ◽

Negative Symptoms ◽

Psychotic Disorders ◽

Cannabis Use ◽

First Episode ◽

Global Functioning

AbstractBackground:Gender differences in symptomatology in chronic schizophrenia and first episode psychosis patients have often been reported. However, little is known about gender differences in those at risk of psychotic disorders. This study investigated gender differences in symptomatology, drug use, comorbidity (i.e. substance use, affective and anxiety disorders) and global functioning in patients with an at-risk mental state (ARMS) for psychosis.Methods:The sample consisted of 336 ARMS patients (159 women) from the prodromal work package of the EUropean network of national schizophrenia networks studying Gene-Environment Interactions (EU-GEI; 11 centers). Clinical symptoms, drug use, comorbidity and functioning were assessed at first presentation to an early detection center using structured interviews.Results:In unadjusted analyses, men were found to have significantly higher rates of negative symptoms and current cannabis use while women showed higher rates of general psychopathology and more often displayed comorbid affective and anxiety disorders. No gender differences were found for global functioning. The results generally did not change when corrected for possible cofounders (e.g. cannabis use). However, most differences did not withstand correction for multiple testing.Conclusions:Findings indicate that gender differences in symptomatology and comorbidity in ARMS are similar to those seen in overt psychosis and in healthy controls. However, observed differences are small and would only be reliably detected in studies with high statistical power. Moreover, such small effects would likely not be clinically meaningful.

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Sleep disturbance and sleep-related impairment in psychotic disorders are related to both positive and negative symptoms

Psychiatry Research ◽

10.1016/j.psychres.2020.112857 ◽

2020 ◽

Vol 286 ◽

pp. 112857 ◽

Cited By ~ 2

Author(s):

Jack J. Blanchard ◽

Alexandra Andrea ◽

Ryan D. Orth ◽

Christina Savage ◽

Melanie E. Bennett

Keyword(s):

Sleep Disturbance ◽

Negative Symptoms ◽

Psychotic Disorders ◽

Positive And Negative Symptoms

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S121. OPUS 20, 20 YEAR FOLLOW-UP ON THE OPUS TRIAL

Schizophrenia Bulletin ◽

10.1093/schbul/sbaa031.187 ◽

2020 ◽

Vol 46 (Supplement_1) ◽

pp. S81-S82

Author(s):

Marie Starzer ◽

Carsten Hjorthøj ◽

Nikolai Albert ◽

Merete Nordentoft ◽

Helene Lund Sørensen

Keyword(s):

Negative Symptoms ◽

Participation Rate ◽

First Episode ◽

Episode Psychosis ◽

Health Project ◽

Gaf Scores ◽

Positive And Negative Symptoms ◽

Over Time

Abstract Background Since the first OPUS trial 20 years ago, structured clinical assessments have been collected from a cohort of first episode psychosis patients at 2, 5 and 10 years follow-up. They found that the symptomatology of patients clustered in distinct groups, and they were able to determine stable long-term trajectories of positive and negative symptoms. The Suffolk County Medical health project has followed patients after a first episode psychosis for 20 years. They also found a stable course of trajectories but with an overall significant worsening of symptom severity over time. The 20 year OPUS follow-up will give us the first opportunity to assess the long term outcome in a large representative cohort treated within modern mental health services with treatment available for all. Methods From 1998 to 2000 578 participants were randomized to OPUS or TAU. Baseline characteristics of the cohort were as follows: mean age 26.6 years, 59% were males, 66% had a diagnosis of schizophrenia and 27% had a secondary diagnosis of alcohol or substance abuse At the 20 year follow-up the investigators will be blinded to the original treatment allocation. The patients who wish to participate will be assessed using SAPS, SANS, SCAN, PSP and GAF. Socio-demographic factors and suicidal ideation will be register via self report. Cognitive function will be tested using BACS and all participants will be asked to fill out a number of self-rating questioners including WHO quality of life-BREF, self-perceived health, strengths and difficulties, the parenting scale and self-perceived negative symptoms. Using national Danish registers we can collect information on all former participants regarding the use of psychiatric and general healthcare services, medication, supported housing or homelessness, employment status, substance abuse and mortality. Results The OPUS 20 study started collecting data in Jan 2018. We are attempting to contact as many patients as possible from the 578 participants in the original OPUS cohort. At the time of writing we had included data and attempted contact to 322 participants. Overall 104 people (31,7%) have agreed to participate in the interviews. In the follow-up 10 years ago, the participation-rate was 60% so this is a big drop in participation rate. 41 (14%) have died, 31 (9,5%) were lost due to emigration, homelessness or hidden identity and/or disempowerment. 70 (21,3%) didn’t wish to participate and 76 (23,2%) never responded. Discussion Psychotic disorders and schizophrenia in particular are associated with progressive worsening of symptoms and profound social impairment, and as such are still very stigmatized. Results from the 10 year OPUS follow-up found stable trajectories of positive and negative symptoms over time, with a tendency of reduction and stabilization of positive symptoms but less variation of negative symptoms. They found poor but stable social functioning with a mean GAF score of 55 after 10 years. The Suffolk County mental health project also found stable trajectories of psychopathology measured with SAPS and SANS. They however found progressive worsening of GAF scores declining form 49 points at the beginning to 36 after 20 years. So far we have seen stable GAF scores and SAPS and SANS scores compared to OPUS 10. This gives rise to some optimism about the prognosis for schizophrenia compared to the findings of the Suffolk study. In our study the extensive interviews combined with the data collected form Danish registers give us a unique opportunity to look at the long term course of illness after FEP. The ability to test if previous findings are robust over time will be essential to the development of targeted interventions, differentiated to the needs of different patient groups.

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The Inter-Rater and Test-Retest Reliabilities of Prodromal Symptoms in First-Episode Psychosis

Australian & New Zealand Journal of Psychiatry ◽

10.3109/00048679609065023 ◽

1996 ◽

Vol 30 (4) ◽

pp. 498-504 ◽

Cited By ~ 12

Author(s):

Henry J. Jackson ◽

Patrick D. McGorry ◽

Susan Harrigan ◽

Jenepher Dakis ◽

Lisa Henry ◽

...

Keyword(s):

Field Trial ◽

American Psychiatric Association ◽

Psychotic Disorders ◽

First Episode Psychosis ◽

World Health ◽

First Episode ◽

Prodromal Symptoms ◽

Episode Psychosis ◽

Dsm Iv ◽

Health Organization

Objective: As part of the DSM-IV field trial for psychotic disorders, the authors endeavoured to determine the reliability of the DSM-IV prodromal features for schizophrenia in a first-episode sample. Method: Fifty first-episode psychotic patients were assessed using a semi-structured instrument to determine the presence/absence of nine prodromal symptoms. Inter-rater reliability data were calculated for 25 of the patients, and test-retest data were calculated for the remaining 25 patients. Results: Levels of reliability were poor. Conclusions: The results lend some support to American Psychiatric Association and World Health Organization decisions to omit specific criteria for prodromal features from their respective nosologies.

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