scholarly journals Brief Research Report: A Pilot Study of Cognitive Behavioral Regulation Therapy (CBT-REG) for Young People at High Risk of Early Transition to Bipolar Disorders

2021 ◽  
Vol 11 ◽  
Author(s):  
Jan Scott ◽  
Thomas D. Meyer
Keyword(s):  
At Risk ◽  
High Risk ◽  
Young People ◽  
Case Series ◽  
Bipolar Disorders ◽  
Therapeutic Interventions ◽  
First Episode ◽  
Research Report ◽  
Wide Range ◽  
High Benefit

Attempts to increase early identification of individuals in the early stages of bipolar disorders (i.e., individuals at high risk of bipolar disorders and/or experiencing a subthreshold syndrome with bipolar symptoms) have highlighted the need to develop high benefit-low risk interventions. We suggest that any new psychological therapy should (i) be acceptable to young people seeking help for the first time, (ii) be applicable to “at risk” conditions and sub-syndromal states and (iii) consider pluripotent factors that may be linked to illness progression not only for bipolar disorders specifically but also for other potential disease trajectories. However, evidence indicates that current interventions for youth with emerging mood disorders mainly represent approaches abbreviated from “disorder-specific” therapies used with older adults and are primarily offered to first episode cases of bipolar disorders who are also receiving psychotropic medication. This brief report discusses empirical findings used to construct core targets for therapeutic interventions that might reduce or delay transition to full-threshold bipolar disorders. We describe an intervention that includes strategies for problem-solving, reducing sleep-wake cycle disturbances, self-management of rumination and that addresses the needs of individuals with “sub-threshold” presentations who are probably at risk of developing a bipolar or other major mental disorders. Outcome data from a case series of 14 youth indicates that the intervention appears to demonstrate a relatively high benefit-to-risk ratio, promising levels of engagement with the therapy modules, and the therapy appears to be acceptable to a wide range of help-seeking youth with early expressions of bipolar psychopathology.

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

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.

scholarly journals Circulating lipids associate with future weight gain in individuals with an at-risk mental state and in first-episode psychosis

2020 ◽  
Author(s):  
Santosh Lamichhane ◽  
Alex M. Dickens ◽  
Partho Sen ◽  
Heikki Laurikainen ◽  
Jaana Suvisaari ◽  
...  
Keyword(s):  
At Risk ◽  
Weight Gain ◽  
High Risk ◽  
Psychotic Disorders ◽  
First Episode Psychosis ◽  
Molecular Signature ◽  
First Episode ◽  
Baseline Serum ◽  
Average Life Span ◽  
Episode Psychosis

AbstractPatients with schizophrenia have a lower than average life span, largely due to the increased prevalence of cardiometabolic co-morbidities. Identification of individuals with psychotic disorders with a high risk of rapid weight gain, and the associated development of metabolic complications, is an unmet need as regards public health. Here, we applied mass spectrometry-based lipidomics in a prospective study comprising 48 controls (CTR), 44 first-episode psychosis (FEP) patients and 22 individuals at clinical-high-risk (CHR) for psychosis, from two study centers (Turku/Finland and London/UK). Baseline serum samples were analyzed by lipidomics, while body mass index (BMI) was assessed at baseline and after 12 months. We found that baseline triacylglycerols with low double bond counts and carbon numbers were positively associated with the change in BMI at follow-up. In addition, a molecular signature comprised of two triacylglycerols (TG(48:0) and TG(45:0)), was predictive of weight gain in individuals with a psychotic disorder, with an area under the receiver operating characteristic curve (AUROC) of 0.74 (95% CI: 0.60–0.85). When independently tested in the CHR group, this molecular signature predicted said weight change with AUROC = 0.73 (95% CI: 0.61–0.83). We conclude that molecular lipids may serve as a predictor of weight gain in psychotic disorders in at-risk individuals, and may thus provide a useful marker for identifying individuals who are most prone to developing cardiometabolic co-morbidities.

COGNITIVE THERAPY FOR PREVENTING TRANSITION TO PSYCHOSIS IN HIGH RISK INDIVIDUALS: A CASE SERIES

2003 ◽  
Vol 31 (1) ◽  
pp. 53-67 ◽  
Author(s):  
Paul French ◽  
Anthony P. Morrison ◽  
Lara Walford ◽  
Alice Knight ◽  
Richard P. Bentall
Keyword(s):  
High Risk ◽  
Cognitive Therapy ◽  
Controlled Trial ◽  
Intervention Strategy ◽  
Cognitive Model ◽  
Case Series ◽  
First Episode ◽  
Future Research ◽  
Research Findings ◽  
Further Development

Early interventions for psychosis have recently received a great deal of interest. This is because research findings have indicated the importance of duration of untreated psychosis (DUP) in influencing future prognosis. Most interventions have so far centered around the early identification of first episode cases in an attempt to minimize the DUP. A further development of the early intervention strategy aims to identify high-risk cases prior to the onset of psychosis. Treatment of this at risk group could potentially prevent the onset of psychosis. In this paper we describe three cases from a randomized controlled trial designed to test the feasibility of a cognitive therapy intervention, to prevent the onset of psychosis. These are presented with formulations based on a recent cognitive model conceptualizing the onset of psychosis. Implications of this approach for future research and clinical practice are also discussed.

Majority and Minority Shareholders

2020 ◽  
pp. 119-174
Author(s):  
Paul Davies
Keyword(s):  
At Risk ◽  
High Risk ◽  
Small Group ◽  
Company Law ◽  
Minority Shareholders ◽  
Private Benefits ◽  
Controlling Shareholders ◽  
The Third ◽  
Wide Range ◽  
A Company

Where a company has a controlling or a small group of controlling shareholders, the non-controlling shareholders are at risk that the controllers will extract private benefits of control at the expense of the non-controllers. UK company law contains a wide range of techniques for addressing this issue, some more effective than others. This chapter begins by examining the various ways in which well-advised investors can contract for protection before they enter the company and how the law protects the agreements reached. The second part discusses rights to exit the company upon the occurrence of certain events. The third part discusses disclosure rights, designed to bring self-dealing transactions into the open. The fourth focuses on ways of structuring the board or shareholder body when the decision before it carries a high risk of self-dealing. The final part considers cases where the courts review the substantive fairness of the controllers’ conduct, notably, but not only, the provisions on ‘unfair prejudice.

5. Majority and Minority Shareholders

2020 ◽  
pp. 119-174
Author(s):  
Paul Davies
Keyword(s):  
At Risk ◽  
High Risk ◽  
Small Group ◽  
Company Law ◽  
Minority Shareholders ◽  
Private Benefits ◽  
Controlling Shareholders ◽  
The Third ◽  
Wide Range ◽  
A Company

Where a company has a controlling or a small group of controlling shareholders, the non-controlling shareholders are at risk that the controllers will extract private benefits of control at the expense of the non-controllers. UK company law contains a wide range of techniques for addressing this issue, some more effective than others. This chapter begins by examining the various ways in which well-advised investors can contract for protection before they enter the company and how the law protects the agreements reached. The second part discusses rights to exit the company upon the occurrence of certain events. The third part discusses disclosure rights, designed to bring self-dealing transactions into the open. The fourth focuses on ways of structuring the board or shareholder body when the decision before it carries a high risk of self-dealing. The final part considers cases where the courts review the substantive fairness of the controllers’ conduct, notably, but not only, the provisions on ‘unfair prejudice.

scholarly journals S241. FACTORS ASSOCIATED WITH EARLY RISK OF DISENGAGEMENT FROM EARLY PSYCHOSIS INTERVENTION SERVICES

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S130-S131
Author(s):  
Nicole Kozloff ◽  
Aristotle Voineskos ◽  
George Foussias ◽  
Alexia Polillo ◽  
Sean Kidd ◽  
...  
Keyword(s):  
At Risk ◽  
Substance Use ◽  
Logistic Regression ◽  
Young People ◽  
Family Involvement ◽  
The Body ◽  
Early Psychosis ◽  
First Episode ◽  
Factors Associated ◽  
Race Ethnicity

Abstract Background Despite the body of evidence supporting early psychosis intervention (EPI) programs for young people with psychotic disorders, approximately 30% of individuals with first-episode psychosis disengage from care. To date, two factors, lack of family involvement and presence of a substance use disorder, have emerged as robust predictors of EPI disengagement. Several factors associated with service disengagement in mental health care more broadly have not been well-studied in EPI; some of these, such as homelessness and ethnicity, may be of particular importance to urban, multicultural populations, and ethnicity in particular has been shown to affect pathways into EPI services. Early missed appointments may signal risk for subsequent service disengagement. We sought to identify early predictors of disengagement risk in an urban EPI program. Methods We conducted a prospective chart review of consecutive patients accepted for services in a large, urban EPI program in Toronto, Canada in a 3-month period from July 4-October 3, 2018. Patients were observed in their first 3 months of treatment. The primary outcome of interest was risk of disengagement, defined as having missed at least 1 appointment without cancellation. Extracted data included a variety of demographic and clinical information. The principal investigator trained 2 data abstractors on the first 50 charts; subsequent agreement on the next 5 charts was 88%. Based on previous literature, we hypothesized that risk of disengagement would be increased in individuals with problem substance use, experiences of homelessness, and nonwhite race/ethnicity and decreased in individuals with family involvement in their care. We used logistic regression to examine the odds of disengagement associated with univariate predictors individually, and then together in a multivariate model. Results Seventy-three patients were consecutively admitted to EPI services in the 3-month period. Of these individuals, 59% (N=43) were identified as being at risk of disengagement based on having missed at least 1 appointment without cancellation. In the full sample, 71% (N=52) identified as nonwhite, 23% (N=17) had a documented experience of homelessness, 52% (N=38) had problem substance use, and 73% (N=53) had family involved in their care. In univariate logistic regression, only problem substance use was associated with risk of disengagement (OR=2.91, 95% CI 1.11–7.66); no significant associations were identified with race/ethnicity, experience of homelessness, or family involvement. In multivariate logistic regression, once we controlled for these other factors, the association between risk of disengagement and problem substance use was attenuated and no longer statistically significant (OR=2.15, 95% CI 0.77–5.97). Discussion In this small study of early disengagement in an urban EPI program, only problem substance use was associated with increased odds of missing an appointment, but not when we controlled for other factors thought to be associated with disengagement. Larger studies may be required to identify factors with small but important effects. These factors may be used to identify young people at risk of disengagement from EPI services early in care in order to target them for increased engagement efforts.

Childhood behaviour, psychotic symptoms and psychosis onset in young people at high risk of schizophrenia: early findings from the Edinburgh High Risk Study

2002 ◽  
Vol 32 (1) ◽  
pp. 173-179 ◽  
Author(s):  
P. M. MILLER ◽  
M. BYRNE ◽  
A. HODGES ◽  
S. M. LAWRIE ◽  
E. C. JOHNSTONE
Keyword(s):  
At Risk ◽  
High Risk ◽  
Young People ◽  
Child Behavior ◽  
Aggressive Behaviour ◽  
Child Behavior Checklist ◽  
Somatic Symptoms ◽  
Study Groups ◽  
Psychotic Symptoms ◽  
Neurodevelopmental Abnormalities

Background. Several studies suggest that many patients with schizophrenia have pre-morbid neurodevelopmental abnormalities. This study examines how behavioural abnormalities are associated with mild psychotic symptoms and later schizophrenic illness.Methods. Maternal ratings on the Child Behavior Checklist (CBCL) of the early behaviour of 155 subjects were obtained at entry to the Edinburgh study of people at high risk of schizophrenia. These maternal ratings were compared in those with and without psychotic symptoms and used to predict the later onset of psychosis.Results. The CBCL syndrome scores for the children prior to age 13 did not distinguish any of the study groups at entry to the study. In the ratings made for the subjects when aged from 13 to 16, delinquent behaviour and ‘other problems’ were weakly associated with these symptoms. However, with the exception of somatic symptoms and thought problems, the age 13–16 scales were significant predictors of later schizophrenic illness. This was true also for some of the ratings prior to age 13.Conclusions. Various behaviours, in particular, withdrawn and delinquent–aggressive behaviour in adolescents at risk of schizophrenia may predict later onset of the illness. These behaviours, however, are far less predictive of isolated psychotic symptoms prior to psychosis onset.

scholarly journals Association Between Circulating Lipids and Future Weight Gain in Individuals With an At-Risk Mental State and in First-Episode Psychosis

2020 ◽  
Author(s):  
Santosh Lamichhane ◽  
Alex M Dickens ◽  
Partho Sen ◽  
Heikki Laurikainen ◽  
Faith Borgan ◽  
...  
Keyword(s):  
At Risk ◽  
Weight Gain ◽  
High Risk ◽  
Psychotic Disorders ◽  
First Episode Psychosis ◽  
Molecular Signature ◽  
First Episode ◽  
Baseline Serum ◽  
Average Life Span ◽  
Episode Psychosis

Abstract Patients with schizophrenia have a lower than average life span, largely due to the increased prevalence of cardiometabolic comorbidities. There is an unmet public health need to identify individuals with psychotic disorders who have a high risk of rapid weight gain and who are at risk of developing metabolic complications. Here, we applied mass spectrometry-based lipidomics in a prospective study comprising 48 healthy controls (CTR), 44 first-episode psychosis (FEP) patients, and 22 individuals at clinical high risk (CHR) for psychosis, from 2 study centers (Turku, Finland and London, UK). Baseline serum samples were analyzed using lipidomics, and body mass index (BMI) was assessed at baseline and after 12 months. We found that baseline triacylglycerols (TGs) with low double-bond counts and carbon numbers were positively associated with the change in BMI at follow-up. In addition, a molecular signature comprised of 2 TGs (TG[48:0] and TG[45:0]) was predictive of weight gain in individuals with a psychotic disorder, with an area under the receiver operating characteristic curve (AUROC) of 0.74 (95% CI: 0.60–0.85). When independently tested in the CHR group, this molecular signature predicted said weight change with AUROC = 0.73 (95% CI: 0.61–0.83). We conclude that molecular lipids may serve as a predictor of weight gain in psychotic disorders in at-risk individuals and may thus provide a useful marker for identifying individuals who are most prone to developing cardiometabolic comorbidities.

Positive and Negative Affect in Individuals at High and Low Risk for Bipolar Disorders

2009 ◽  
Vol 30 (3) ◽  
pp. 169-175 ◽  
Author(s):  
Thomas D. Meyer ◽  
Marina Baur
Keyword(s):  
At Risk ◽  
High Risk ◽  
Negative Affect ◽  
Environmental Changes ◽  
Bipolar Disorders ◽  
Emotional Reactions ◽  
Male Students ◽  
Hypomanic Personality Scale ◽  
Time Courses ◽  
Multidimensional Concept

Introduction: Affective disorders are thought to be associated primarily with changes in positive affect (PA) and secondarily with changes in negative affect (NA). Based upon a dysregulation model, we assumed that people at risk for bipolar disorders show stronger emotional reactions – especially with reference to PA – in certain situations (e.g., facing success). Methods: Seventy-two male students completed the Hypomanic Personality Scale and were interviewed with the Structured Clinical Interview for DSM-IV (SCID). The high-risk persons (n = 16) and controls (n = 56) completed an intelligence test and received success feedback. Afterward they played with dice. Affect was repeatedly assessed. Results: High-risk individuals generally reported more PA than controls but no significant interaction with time emerged. Different aspects of PA, however, showed different time courses. Conclusion: Despite methodological limitations, the results are in line with prior research showing that individuals at risk for bipolar disorder often report elevated levels of PA. It is unclear, however, if the available measures are the most appropriate because PA might be a multidimensional concept with its facets being differently affected by time and experimental or environmental changes.

At-risk-states for bipolar disorder

2011 ◽  
Vol 26 (S2) ◽  
pp. 2099-2099
Author(s):  
P. Conus
Keyword(s):  
At Risk ◽  
Bipolar Disorder ◽  
Psychotic Disorders ◽  
Bipolar Disorders ◽  
Small Sample ◽  
First Episode ◽  
Prodromal Phase ◽  
Ultra High Risk ◽  
Risk Patients ◽  
New Research

Early intervention strategies have been developed over the past 20 years for psychotic disorders and recent studies have proven their efficacy. However, most of the attention has been drawn to schizophrenia, and affective psychoses have been neglected. In the recent past, new research has identified a similar need for earlier intervention in bipolar disorders, and prodrome to bipolar disorder has emerged as a key domain to investigate. Despite the complexity of this issue due to the lack of a clear consensus regarding definitions of the various stages of the disorder, some progress has been made in this domain.Two recent retrospective studies have identified a prodromal phase to first episode mania lasting between 6 and 18 months, and have identified a range of symptoms that occur during this period. It is however likely that on the basis of symptomatic profile, identification of at risk patients would be difficult, considering their low specificity. Two complementary directions have been recently proposed in order to refine such an approach. The first strategy, based on at-risk profiles inspired by the Ultra High Risk concept developed for psychosis, has yielded some promising results on a small sample of patients. The second is based on the combination of identified risk symptoms with both risk factors and markers of vulnerability into a First Episode Mania Prodrome Inventory which is currently under validation.

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