Borderline personality pathology in young people at ultra high risk of developing a psychotic disorder

BackgroundEffective interventions, targeting key contributory causal factors, are needed to prevent the emergence of severe mental health problems in young people. Insomnia is a common clinical issue that is problematic in its own right but that also leads to the development and persistence of psychotic experiences. The implication is that treating sleep problems may prevent the onset of psychosis. We collected initial case series data with 12 young people at ultra-high-risk of psychosis. Post-intervention, there were improvements in sleep, depression and psychotic experiences. Now we test the feasibility of a randomised controlled trial, with a clinical aim to treat sleep problems and hence reduce depression, psychotic experiences, and prevent transition to psychosis.Methods and analysisA randomised controlled feasibility trial will be conducted. Forty patients aged 14 to 25 years who are at ultra-high-risk of psychosis and have sleep disturbance will be recruited from National Health Service (NHS) mental health services. Participants will be randomised to receive either a novel, targeted, youth-focussed sleep intervention in addition to usual care or usual care alone. Assessor-blinded assessments will be conducted at baseline, 3 months (post-intervention) and 9 months (follow-up). The eight-session psychological intervention will target the key mechanisms which disrupt sleep: circadian rhythm irregularities, low sleep pressure, and hyperarousal. To gain an in-depth understanding of participants’ views on the acceptability of the intervention and study procedures, 16 participants (n=10 intervention, n=6 control) will take part in qualitative interviews. Analyses will focus on feasibility outcomes (recruitment, retention, and treatment uptake rates) and provide initial CI estimates of intervention effects. Thematic analysis of the qualitative interviews will assess the acceptability of the intervention and trial procedures.Ethics and disseminationThe trial has received ethical approval from the NHS Health Research Authority. Findings will be disseminated through peer-reviewed publications, conference presentations, and lay networks.Trial registration numberISRCTN85601537.

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Fluvoxamine may prevent onset of psychosis: a case report of a patient at ultra-high risk of psychotic disorder

Annals of General Psychiatry ◽

10.1186/1744-859x-10-26 ◽

2011 ◽

Vol 10 (1) ◽

pp. 26 ◽

Cited By ~ 7

Author(s):

Shigenori Tadokoro ◽

Nobuhisa Kanahara ◽

Shuichi Kikuchi ◽

Kenji Hashimoto ◽

Iyo Masaomi

Keyword(s):

Case Report ◽

High Risk ◽

Psychotic Disorder ◽

Ultra High Risk

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Predictors of treatment response in young people at ultra-high risk for psychosis who received long-chain omega-3 fatty acids

Translational Psychiatry ◽

10.1038/tp.2014.134 ◽

2015 ◽

Vol 5 (1) ◽

pp. e495-e495 ◽

Cited By ~ 27

Author(s):

G P Amminger ◽

A Mechelli ◽

S Rice ◽

S-W Kim ◽

C M Klier ◽

...

Keyword(s):

Fatty Acids ◽

High Risk ◽

Young People ◽

Treatment Response ◽

Omega 3 Fatty Acids ◽

Omega 3 ◽

Ultra High Risk ◽

Long Chain

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Ultra-high-risk paradigm: lessons learnt and new directions

Evidence-Based Mental Health ◽

10.1136/ebmental-2018-300061 ◽

2018 ◽

Vol 21 (4) ◽

pp. 131-133 ◽

Cited By ~ 17

Author(s):

Patrick D McGorry ◽

Cristina Mei

Keyword(s):

High Risk ◽

Mental Disorders ◽

Psychotic Disorder ◽

Psychotic Disorders ◽

Evidence Base ◽

Ultra High Risk ◽

Underlying Mechanisms ◽

Staging Model ◽

Definition Of ◽

New Generation

Within the embryonic early psychosis field in the early 1990s, the conceptualisation and definition of an at-risk or ultra-high-risk (UHR) mental state for psychosis was a breakthrough which transformed the clinical and research landscape in psychiatry. Twenty-five years later, we have a new evidence base that has illuminated the neurobiology of the onset phase of psychotic disorder, delivered Cochrane level 1 evidence showing that the onset of full-threshold sustained psychotic disorder can be at least delayed, and is paving the way to a new generation of transdiagnostic research. Here, we document the contribution of the UHR approach to understanding the underlying mechanisms of psychosis onset as well as the long-term outcomes. Particularly, we highlight that psychosis onset can be delayed in those meeting UHR criteria and that these criteria have a higher valence for subsequent psychotic disorders and some valence for persistent non-psychotic syndromes. Critiques have helped to identify some of the limitations of this paradigm, which are acknowledged. These include evidence that psychotic disorders can emerge more acutely and from other, as yet undefined, precursor states. Rather than defending, or alternatively questioning the value of, the UHR approach, we propose a broader, transdiagnostic staging model that is consistent with the pluripotent and variably comorbid trajectories for mental disorders. This approach moves beyond psychosis to capture a wider range of subthreshold symptoms and full-threshold disorders, thus enhancing prediction for the emergence and progression of a range of mental disorders, as well as providing new avenues for early intervention and prevention.

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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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