Neural Circuitry of Novelty Salience Processing in Psychosis Risk: Association With Clinical Outcome

Abstract Psychosis has been proposed to develop from dysfunction in a hippocampal-striatal-midbrain circuit, leading to aberrant salience processing. Here, we used functional magnetic resonance imaging (fMRI) during novelty salience processing to investigate this model in people at clinical high risk (CHR) for psychosis according to their subsequent clinical outcomes. Seventy-six CHR participants as defined using the Comprehensive Assessment of At-Risk Mental States (CAARMS) and 31 healthy controls (HC) were studied while performing a novelty salience fMRI task that engaged an a priori hippocampal-striatal-midbrain circuit of interest. The CHR sample was then followed clinically for a mean of 59.7 months (~5 y), when clinical outcomes were assessed in terms of transition (CHR-T) or non-transition (CHR-NT) to psychosis (CAARMS criteria): during this period, 13 individuals (17%) developed a psychotic disorder (CHR-T) and 63 did not. Functional activation and effective connectivity within a hippocampal-striatal-midbrain circuit were compared between groups. In CHR individuals compared to HC, hippocampal response to novel stimuli was significantly attenuated (P = .041 family-wise error corrected). Dynamic Causal Modelling revealed that stimulus novelty modulated effective connectivity from the hippocampus to the striatum, and from the midbrain to the hippocampus, significantly more in CHR participants than in HC. Conversely, stimulus novelty modulated connectivity from the midbrain to the striatum significantly less in CHR participants than in HC, and less in CHR participants who subsequently developed psychosis than in CHR individuals who did not become psychotic. Our findings are consistent with preclinical evidence implicating hippocampal-striatal-midbrain circuit dysfunction in altered salience processing and the onset of psychosis.

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Psychosis Risk Syndrome andDSM-5: Time for a Dimensional Approach to At-Risk Mental States?

Clinical Schizophrenia & Related Psychoses ◽

10.3371/csrp.5.3.6 ◽

2011 ◽

Vol 5 (3) ◽

pp. 155-158 ◽

Cited By ~ 3

Author(s):

Andrea Raballo ◽

Frank Larøi

Keyword(s):

At Risk ◽

Mental States ◽

Dimensional Approach ◽

Psychosis Risk ◽

At Risk Mental States

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Schizophrenia: An update

European Psychiatry ◽

10.1016/s0924-9338(11)73886-x ◽

2011 ◽

Vol 26 (S2) ◽

pp. 2183-2183

Author(s):

W. Fleischhacker

Keyword(s):

Therapeutic Relationship ◽

Mental States ◽

Intervention Programs ◽

First Episode ◽

Compliance Behavior ◽

Psychosis Risk ◽

Management Recommendations ◽

Outpatient Settings ◽

Established Treatment ◽

At Risk Mental States

Schizophrenia is a serious mental disorder which presents with both diagnostic and management challenges. In process of developing DSM5, the inclusion of a Psychosis Risk Syndrome is currently being discussed. This is also the focus of early intervention programs which should facilitate to diagnose the disorder as early as possible and to prevent long durations of untreated psychosis (DUP). As only about 20–40% of young people with At Risk Mental States (ARMS) develop a full blown psychotic disorder, the challenge is to identify people with ARMS who will eventually receive a diagnosis of schizophrenia. Various interventions have been evaluated in ARMS probands, yet it is still too early to make management recommendations.Once the diagnosis of schizophrenia has been established, treatment must commence as early as possible, in order to prevent long DUP's. First episode patients show a very good chance of remission, 40–60% have been reported.It is generally recommended to switch patients to clozapine after two or three different antipsychotics have been unsuccessfully tried. In the case of clozapine non-response, the evidence for further interventions becomes extremely weak.Once improvement and/or remission has been achieved, maintenance treatment is the next big challenge. As most relapses are related to compliance problems, assuring a positive therapeutic relationship with an influence on compliance behavior becomes a key issue.Managing schizophrenia patients requires expert skills, ideally provided by multiprofessional teams both in inpatient and outpatient settings. Sufficient attention must also be given to the somatic health of schizophrenia patients.

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A randomised, double-blind, placebo-controlled trial of minocycline and/or omega-3 fatty acids added to treatment as usual for at-risk mental states (NAYAB): study protocol

Trials ◽

10.1186/s13063-017-2275-y ◽

2017 ◽

Vol 18 (1) ◽

Cited By ~ 7

Author(s):

Inti Qurashi ◽

Imran B. Chaudhry ◽

Ameer B. Khoso ◽

Sana Farooque ◽

Steve Lane ◽

...

Keyword(s):

Fatty Acids ◽

Study Protocol ◽

Controlled Trial ◽

Mental States ◽

Omega 3 Fatty Acids ◽

Omega 3 ◽

Double Blind ◽

Treatment As Usual ◽

Double Blind Placebo ◽

At Risk Mental States

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Predicting clinical outcomes in the Machine Learning era: The Piacenza score a purely data driven approach for mortality prediction in COVID-19 Pneumonia (Preprint)

10.2196/preprints.29058 ◽

2021 ◽

Author(s):

Geza Halasz ◽

Michela Sperti ◽

Matteo Villani ◽

Umberto Michelucci ◽

Piergiuseppe Agostoni ◽

...

Keyword(s):

Machine Learning ◽

Clinical Outcomes ◽

Naive Bayes ◽

Validation Cohort ◽

A Priori ◽

Naïve Bayes ◽

Data Driven ◽

Brier Score ◽

Bayes Classifier ◽

Naïve Bayes Classifier

BACKGROUND Several models have been developed to predict mortality in patients with Covid-19 pneumonia, but only few have demonstrated enough discriminatory capacity. Machine-learning algorithms represent a novel approach for data-driven prediction of clinical outcomes with advantages over statistical modelling. OBJECTIVE To developed the Piacenza score, a Machine-learning based score, to predict 30-day mortality in patients with Covid-19 pneumonia METHODS The study comprised 852 patients with COVID-19 pneumonia, admitted to the Guglielmo da Saliceto Hospital (Italy) from February to November 2020. The patients’ medical history, demographic and clinical data were collected in an electronic health records. The overall patient dataset was randomly splitted into derivation and test cohort. The score was obtained through the Naïve Bayes classifier and externally validated on 86 patients admitted to Centro Cardiologico Monzino (Italy) in February 2020. Using a forward-search algorithm six features were identified: age; mean corpuscular haemoglobin concentration; PaO2/FiO2 ratio; temperature; previous stroke; gender. The Brier index was used to evaluate the ability of ML to stratify and predict observed outcomes. A user-friendly web site available at (https://covid.7hc.tech.) was designed and developed to enable a fast and easy use of the tool by the final user (i.e., the physician). Regarding the customization properties to the Piacenza score, we added a personalized version of the algorithm inside the website, which enables an optimized computation of the mortality risk score for a single patient, when some variables used by the Piacenza score are not available. In this case, the Naïve Bayes classifier is re-trained over the same derivation cohort but using a different set of patient’s characteristics. We also compared the Piacenza score with the 4C score and with a Naïve Bayes algorithm with 14 features chosen a-priori. RESULTS The Piacenza score showed an AUC of 0.78(95% CI 0.74-0.84 Brier-score 0.19) in the internal validation cohort and 0.79(95% CI 0.68-0.89, Brier-score 0.16) in the external validation cohort showing a comparable accuracy respect to the 4C score and to the Naïve Bayes model with a-priori chosen features, which achieved an AUC of 0.78(95% CI 0.73-0.83, Brier-score 0.26) and 0.80(95% CI 0.75-0.86, Brier-score 0.17) respectively. CONCLUSIONS A personalized Machine-learning based score with a purely data driven features selection is feasible and effective to predict mortality in patients with COVID-19 pneumonia.

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Comprehensive Assessment of at-Risk Mental States--Arabic Version

PsycTESTS Dataset ◽

10.1037/t52047-000 ◽

2015 ◽

Author(s):

Amel Braham ◽

Ahmed Souhail Bannour ◽

Asma Ben Romdhane ◽

Barnabay Nelson ◽

Iheb Bougumiza ◽

...

Keyword(s):

At Risk ◽

Mental States ◽

Comprehensive Assessment ◽

Arabic Version ◽

At Risk Mental States

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Reply to Williamson on Intuition, Understanding, and the A Priori1

Debating the A Priori ◽

10.1093/oso/9780198851707.003.0015 ◽

2020 ◽

pp. 214-226

Author(s):

Paul Boghossian ◽

Timothy Williamson

Keyword(s):

A Priori ◽

Mental States ◽

A Priori Justification

This paper argues that Williamson fails to produce successful counterexamples to the existence of understanding–assent links, in particular because he fails to show that the expert in his cases has lost underived dispositions to assent. The paper gives grounds for rejecting Williamson’s argument that intuitions, supposing them to exist, cannot be the source of distinctively a priori justification. Finally, it is argued that Williamson’s argument against the existence of intuitions (understood as sui generis states of intellectual seeming) flounders because it rests on a misguided and naïve dichotomy between ‘introspectable’ and ‘postulated’ mental states.

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Unconscious mental states

Routledge Encyclopedia of Philosophy ◽

10.4324/9780415249126-w046-1 ◽

2018 ◽

Author(s):

Georges Rey

Keyword(s):

Computational Models ◽

A Priori ◽

Mental States ◽

A Priori Knowledge ◽

Pupillary Dilation ◽

Mental Life ◽

Mental Processes ◽

The Unconscious ◽

Wide Range ◽

The Moment

Unconscious phenomena are those mental phenomena which their possessor cannot introspect, not only at the moment at which the phenomenon occurs, but even when prompted (‘Do you think/want/…?’). There are abundant allusions to many kinds of unconscious phenomena from classical times to Freud. Most notably, Plato in his Meno defended a doctrine of anamnesis according to which a priori knowledge of, for example, geometry is ‘recollected’ from a previous life. But the notion of a rich, unconscious mental life really takes hold in nineteenth-century writers, such as Herder, Hegel, Helmholtz and Schopenhauer. It is partly out of this latter tradition that Freud’s famous postulations of unconscious, ‘repressed’ desires and memories emerged. Partly in reaction to the excesses of introspection and partly because of the rise of computational models of mental processes, twentieth-century psychology has often been tempted by Lashley’s view that ‘no activity of mind is ever conscious’ (1956). A wide range of recent experiments do suggest that people can be unaware of a multitude of sensory cognitive factors (for example, pupillary dilation, cognitive dissonance, subliminal cues to problem-solving) that demonstrably affect their behaviour. And Weiskrantz has documented cases of ‘blindsight’ in which patients with damage to their visual cortex can be shown to be sensitive to visual material they sincerely claim they cannot see. The most controversial cases of unconscious phenomena are those which the agent could not possibly introspect, even in principle. Chomsky ascribes unconscious knowledge of quite abstract principles of grammar to adults and even newborn children that only a linguist could infer. Many philosophers have found these claims about the unconscious unconvincing, even incoherent. However, they need to show how the evidence cited above could be otherwise explained, and why appeals to the unconscious have seemed so perfectly intelligible throughout history.

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Psychopathology

The ITC International Handbook of Testing and Assessment ◽

10.1093/med:psych/9780199356942.003.0011 ◽

2016 ◽

pp. 147-170 ◽

Cited By ~ 4

Author(s):

Eduardo Fonseca Pedrero ◽

Diane C. Gooding ◽

Martin Debbané ◽

José Muñiz

Keyword(s):

Risk Assessment ◽

At Risk ◽

High Risk ◽

Mental States ◽

Psychological Process ◽

Cognitive Symptoms ◽

Need For Care ◽

Measurement Instruments ◽

Psychosis Risk ◽

Higher Cognitive Functions

This chapter reviews the assessment of psychopathology, with a focus on psychosis and clinically related phenomena and conditions, such as prodromal phases and at-risk mental states of psychosis. The psychosis syndrome, which is characterized by a disruption of higher cognitive functions, can be found when any basic psychological process (e.g., memory, attention, etc.) is altered. It is used here as an example of psychopathological disorder. The chapter begins with an overview of the psychosis syndrome as a model of psychopathological disorder, emphasizing its core domains (i.e., positive, negative, and cognitive symptoms). It discusses the main psychological tests and procedures for psychosis assessment and provides an overall review of measurement instruments for psychosis risk assessment from both clinical and psychometric high-risk paradigms, where psychological testing plays a crucial role in terms of detecting people at risk for psychosis prior to developing serious mental disorder and need for care.

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