4.3 ENHANCING SOCIAL FUNCTIONING AND LONG-TERM RECOVERY IN YOUNG PEOPLE WITH FIRST EPISODE PSYCHOSIS (FEP) AND YOUNG PEOPLE AT ULTRA HIGH RISK (UHR) FOR PSYCHOSIS: A NOVEL ONLINE SOCIAL THERAPY APPROACH

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.

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Sexuality in Ultra-High Risk for Psychosis and First-Episode Psychosis. A Systematic Review of Literature

Frontiers in Psychiatry ◽

10.3389/fpsyt.2021.750033 ◽

2021 ◽

Vol 12 ◽

Author(s):

Giacomo Ciocca ◽

Tommaso B. Jannini ◽

Michele Ribolsi ◽

Rodolfo Rossi ◽

Cinzia Niolu ◽

...

Keyword(s):

At Risk ◽

High Risk ◽

Young People ◽

First Episode Psychosis ◽

Sexual Life ◽

Psychotic Symptoms ◽

First Episode ◽

Episode Psychosis ◽

Ultra High Risk

A considerable body of literature reports that individuals with psychotic disorders often suffer from sexual dysfunctions (SDs), with these representing a major unmet need. Long-term antipsychotic drug treatment may be the main cause for SDs in psychotic patients, through a plethora of different mechanisms, including prolactin dyscrasia, histamine-mediated sedation, and serotonin-induced sexual demotivation. However, a few pieces of evidence treat sexuality in patients at risk or the onset of psychosis. For this purpose, we systematically reviewed literature of the last 10 years in order to investigate sexuality in ultra-high risk (UHR) for psychosis and first-episode psychosis (FEP). We included in our review 34 articles fitting our research criteria on SDs in UHR and FEP. Evidence of SDs in the transition from UHR to FEP emerges through the selected studies. In FEP, sexuality is affected by the severity of the psychotic symptoms and, in some cases, by the iatrogenic effects of psychopharmacological treatment. Further experimental and clinical studies should systematically investigate the role of sexual functioning in the transition from UHR to FEP and, consequently, clarify whether or not SDs could be considered a possible marker for the onset of psychosis in at-risk populations. Moreover, psychiatrists and clinical psychologists should take into consideration the role of sexual life in young people with prodromal mental symptoms or at the onset of psychosis. Focusing on a thorough sexual evaluation might be a major challenge that could break down barriers of mental health promotion among young people with schizophrenia-spectrum disorders and therefore achieve better clinical outcomes.

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Characterising Usage of a Multicomponent Digital Intervention to Predict Treatment Outcomes in First-Episode Psychosis: A Cluster Analysis (Preprint)

10.2196/preprints.29211 ◽

2021 ◽

Author(s):

Shaunagh O'Sullivan ◽

Lianne Schmaal ◽

Simon D'Alfonso ◽

Yara J Toenders ◽

Lee Valentine ◽

...

Keyword(s):

Young People ◽

Treatment Outcomes ◽

Social Functioning ◽

Negative Symptoms ◽

User Profile ◽

First Episode Psychosis ◽

First Episode ◽

User Profiles ◽

Episode Psychosis ◽

Social Components

BACKGROUND Multicomponent digital interventions offer the potential for tailored and flexible interventions that aim to address high attrition rates and increase engagement, an area of concern in digital mental health. However, increased flexibility in usage makes it difficult to determine which components lead to improved treatment outcomes. OBJECTIVE This study aimed to identify user profiles on Horyzons, an 18-month digital relapse prevention intervention that incorporates therapeutic content and social networking, along with clinical, vocational and peer support, and to examine the predictive value of these user profiles for treatment outcomes. A secondary objective was to compare each user profile with young people receiving treatment as usual (TAU). METHODS Participants comprised 82 young people (16-27 years of age) with access to Horyzons and 84 receiving TAU, recovering from first-episode psychosis. Six-month usage data from the therapy and social networking components of Horyzons were used as features for K-means clustering for joint trajectories to identify user profiles. Social functioning, psychotic symptoms, depression and anxiety were assessed at baseline and six-month follow-up. General linear mixed models were used to examine the predictive value of user profiles for treatment outcomes, and between each user profile with TAU. RESULTS Three user profiles were identified based on system usage metrics including: (a) low usage; (b) maintained usage of social components; and (c) maintained usage of both therapy and social components. The maintained therapy and social group showed improvements in social functioning (F (2, 51) = 3.58; P = .04), negative symptoms (F (2, 51) = 4.45; P = .02) and overall psychiatric symptom severity (F (2, 50) = 3.23; P = .048) compared to the other user profiles. This group also showed improvements in social functioning (F (1, 62) = 4.68; P = .03), negative symptoms (F (1, 62) = 14.61; P = <.001) and overall psychiatric symptom severity (F (1, 63) = 5.66; P = .02) compared to TAU. Conversely, the maintained social group showed increases in anxiety compared to TAU (F (1, 57) = 7.65; P = .01). No differences were found between the low usage group and TAU on treatment outcomes. CONCLUSIONS Continued engagement with both therapy and social components might be key in achieving long-term recovery. Maintained social usage and low usage outcomes were broadly comparable to TAU, emphasizing the importance of maintaining engagement for improved treatment outcomes. Although the social network may be a key ingredient to increase sustained engagement, as users engaged with this more consistently, it should be leveraged as a tool to engage young people with therapeutic content to bring about social and clinical benefits.

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S150. EMOTIONAL BEHAVIOUR IN HIGH-RISK AND FIRST-EPISODE PSYCHOSIS

Schizophrenia Bulletin ◽

10.1093/schbul/sbaa031.216 ◽

2020 ◽

Vol 46 (Supplement_1) ◽

pp. S93-S93

Author(s):

Irina Falkenberg ◽

Huai-Hsuan Tseng ◽

Gemma Modinos ◽

Barbara Wild ◽

Philip McGuire ◽

...

Keyword(s):

High Risk ◽

Emotion Recognition ◽

Psychotic Disorders ◽

First Episode Psychosis ◽

First Episode ◽

Healthy Controls ◽

Emotional Faces ◽

Facial Movements ◽

Episode Psychosis ◽

Ultra High Risk

Abstract Background Studies indicate that people with schizophrenia and first-episode psychosis experience deficits in their ability to accurately detect and display emotions through facial expressions, and that functioning and symptoms are associated with these deficits. This study aims to examine how emotion recognition and facial emotion expression are related to functioning and symptoms in a sample of individuals at ultra-high risk, first-episode psychosis and healthy controls. Methods During fMRI, we combined the presentation of emotional faces with the instruction to react with facial movements predetermined and assigned. 18 patients with first-episode psychosis (FEP), 18 individuals at ultra high risk of psychosis (UHR) and 22 healthy controls (HCs) were examined while viewing happy, sad, or neutral faces and were instructed to simultaneously move the corners of their mouths either (a). upwards or (b). downwards, or (c). to refrain from movement. The subjects’ facial movements were recorded with an MR-compatible video camera. Results Neurofunctional and behavioral response to emotional faces were measured. Analyses have only recently commenced and are ongoing. Full results of the clinical and functional impact of behavioral and neuroimaging results will be presented at the meeting. Discussion Increased knowledge about abnormalities in emotion recognition and behaviour as well as their neural correlates and their impact on clinical measures and functional outcome can inform the development of novel treatment approaches to improve social skills early in the course of schizophrenia and psychotic disorders.

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Long-term follow-up of all-cause and unnatural death in young people with first-episode psychosis

Schizophrenia Research ◽

10.1016/j.schres.2014.07.042 ◽

2014 ◽

Vol 159 (1) ◽

pp. 70-75 ◽

Cited By ~ 8

Author(s):

Kally Yuen ◽

Susy M. Harrigan ◽

Andrew J. Mackinnon ◽

Meredith G. Harris ◽

Hok Pan Yuen ◽

...

Keyword(s):

Young People ◽

First Episode Psychosis ◽

First Episode ◽

Unnatural Death ◽

Episode Psychosis ◽

Long Term Follow Up

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Safety and Privacy Outcomes From a Moderated Online Social Therapy for Young People With First-Episode Psychosis

Psychiatric Services ◽

10.1176/appi.ps.201300078 ◽

2014 ◽

Vol 65 (4) ◽

pp. 546-550 ◽

Cited By ~ 33

Author(s):

John F. Gleeson ◽

Reeva Lederman ◽

Greg Wadley ◽

Sarah Bendall ◽

Patrick D. McGorry ◽

...

Keyword(s):

Young People ◽

First Episode Psychosis ◽

First Episode ◽

Social Therapy ◽

Episode Psychosis

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Aripiprazole for Drug-Naive or Antipsychotic-Short-Exposure Subjects With Ultra-High Risk State and First-Episode Psychosis

Journal of Clinical Psychopharmacology ◽

10.1097/jcp.0b013e31827cb017 ◽

2013 ◽

Vol 33 (1) ◽

pp. 18-23 ◽

Cited By ~ 11

Author(s):

Chen-Chung Liu ◽

Yi-Ling Chien ◽

Ming H. Hsieh ◽

Tzung-Jeng Hwang ◽

Hai-Gwo Hwu ◽

...

Keyword(s):

High Risk ◽

First Episode Psychosis ◽

Short Exposure ◽

First Episode ◽

Episode Psychosis ◽

Ultra High Risk ◽

Drug Naïve

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Prediction of transition from ultra-high risk to first-episode psychosis using a probabilistic model combining history, clinical assessment and fatty-acid biomarkers

Translational Psychiatry ◽

10.1038/tp.2016.170 ◽

2016 ◽

Vol 6 (9) ◽

pp. e897-e897 ◽

Cited By ~ 38

Author(s):

S R Clark ◽

B T Baune ◽

K O Schubert ◽

S Lavoie ◽

S Smesny ◽

...

Keyword(s):

Fatty Acid ◽

High Risk ◽

Clinical Assessment ◽

Probabilistic Model ◽

First Episode Psychosis ◽

First Episode ◽

Model Combining ◽

Episode Psychosis ◽

Ultra High Risk ◽

Fatty Acid Biomarkers

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Using genetic, cognitive and multi-modal neuroimaging data to identify ultra-high-risk and first-episode psychosis at the individual level

Psychological Medicine ◽

10.1017/s003329171300024x ◽

2013 ◽

Vol 43 (12) ◽

pp. 2547-2562 ◽

Cited By ~ 65

Author(s):

W. Pettersson-Yeo ◽

S. Benetti ◽

A. F. Marquand ◽

F. Dell‘Acqua ◽

S. C. R. Williams ◽

...

Keyword(s):

High Risk ◽

First Episode Psychosis ◽

First Episode ◽

Support Vector ◽

Single Subject ◽

Individual Level ◽

Episode Psychosis ◽

Ultra High Risk ◽

The Individual ◽

Cognitive Data

BackgroundGroup-level results suggest that relative to healthy controls (HCs), ultra-high-risk (UHR) and first-episode psychosis (FEP) subjects show alterations in neuroanatomy, neurofunction and cognition that may be mediated genetically. It is unclear, however, whether these groups can be differentiated at single-subject level, for instance using the machine learning analysis support vector machine (SVM). Here, we used a multimodal approach to examine the ability of structural magnetic resonance imaging (sMRI), functional MRI (fMRI), diffusion tensor neuroimaging (DTI), genetic and cognitive data to differentiate between UHR, FEP and HC subjects at the single-subject level using SVM.MethodThree age- and gender-matched SVM paired comparison groups were created comprising 19, 19 and 15 subject pairs for FEPversusHC, UHRversusHC and FEPversusUHR, respectively. Genetic, sMRI, DTI, fMRI and cognitive data were obtained for each participant and the ability of each to discriminate subjects at the individual level in conjunction with SVM was tested.ResultsSuccessful classification accuracies (p < 0.05) comprised FEPversusHC (genotype, 67.86%; DTI, 65.79%; fMRI, 65.79% and 68.42%; cognitive data, 73.69%), UHRversusHC (sMRI, 68.42%; DTI, 65.79%), and FEPversusUHR (sMRI, 76.67%; fMRI, 73.33%; cognitive data, 66.67%).ConclusionsThe results suggest that FEP subjects are identifiable at the individual level using a range of biological and cognitive measures. Comparatively, only sMRI and DTI allowed discrimination of UHR from HC subjects. For the first time FEP and UHR subjects have been shown to be directly differentiable at the single-subject level using cognitive, sMRI and fMRI data. Preliminarily, the results support clinical development of SVM to help inform identification of FEP and UHR subjects, though future work is needed to provide enhanced levels of accuracy.

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