scholarly journals Neurocognition and Social Cognition— Possibilities for Diagnosis and Treatment in Ultra-High Risk for Psychosis State

2021 ◽  
Vol 12 ◽  
Author(s):  
Katarzyna Rek-Owodziń ◽  
Ernest Tyburski ◽  
Katarzyna Waszczuk ◽  
Jerzy Samochowiec ◽  
Monika Mak
Keyword(s):  
Social Cognition ◽  
High Risk ◽  
Healthcare Workers ◽  
Conceptual Analysis ◽  
Psychotic Disorders ◽  
Treatment Options ◽  
Psychotic Symptoms ◽  
Early Interventions ◽  
Prodromal Phase ◽  
Ultra High Risk

In recent decades, clinicians have developed the construct of ultra-high risk (UHR) for psychosis to characterize the prodromal phase of psychosis or classify people with weakly expressed psychotic symptoms. In this conceptual analysis, we have gathered up-to-date data about the clinical picture of neurocognition and social cognition in people at UHR for psychosis. We also discuss treatment options. A well-chosen therapeutic approach can help to deal with difficulties and delay or even prevent the development of full-blown psychotic disorders in the UHR group. Despite much evidence supporting the benefits of therapy, early interventions are still not as widely used as they should be. Thus, a better understanding of the UHR state is very important for all healthcare workers.

Detecting the first signs of emerging psychosis

2019 ◽  
pp. 57-72
Author(s):  
Frauke Schultze-Lutter
Keyword(s):  
Information Processing ◽  
High Risk ◽  
Psychotic Disorders ◽  
Psychotic Symptoms ◽  
First Episode ◽  
Prodromal Phase ◽  
Risk Detection ◽  
Ultra High Risk ◽  
Positive Symptoms Of Psychosis ◽  
Insight Into

Psychotic disorders are costly and debilitating illnesses. Their prodromal phase usually lasts several years and offers opportunities for indicated prevention. Currently, two risk-detection approaches, developed in adult samples, are typically followed: ultra-high risk (UHR) criteria, developed to predict first-episode psychoses within 12 months; and basic symptom (BS) criteria, aimed at the earliest possible detection of emerging psychoses. The main UHR criterion is defined by attenuated psychotic symptoms, which resemble positive symptoms of psychosis except that some insight into their abnormal nature remains. In contrast, BS criteria include subtle disturbances in information processing, experienced immediately with full insight. Various studies have indicated that using a combination of both approaches might increase sensitivity and support the development of a timely, change-sensitive, and stratified risk-detection method. However, since age might play an important role, both the UHR and BS approach might be less psychosis-predictive and less clinically relevant in children and adolescents.

scholarly journals Assessment and treatment of individuals at high risk for psychosis

2019 ◽  
Vol 25 (3) ◽  
pp. 177-184 ◽  
Author(s):  
Christina Andreou ◽  
Barbara Bailey ◽  
Stefan Borgwardt
Keyword(s):  
High Risk ◽  
Psychotic Disorders ◽  
Treatment Options ◽  
Signs And Symptoms ◽  
Psychotic Symptoms ◽  
List Type ◽  
Evidence Based Treatment ◽  
The Past ◽  
Psychosis Risk ◽  
Assessment And Treatment

SUMMARYEarly detection and specialised early intervention for people at high risk for psychotic disorders have received growing attention in the past few decades, with the aim of delaying or preventing the outbreak of explicit psychotic symptoms and improving functional outcomes. This article summarises criteria for a diagnosis of high psychosis risk, the implications for such a diagnosis and recommendations for treatment.LEARNING OBJECTIVESAfter reading this article you will be able to: •recognise signs and symptoms indicating increased psychosis risk•understand uses and limitations of screening for high psychosis risk, and interpretation of results•recognise evidence-based treatment options for patients at clinical high risk for psychosis.DECLARATION OF INTERESTC.A. has received non-financial support from Sunovion and Lundbeck in the past 36 months.

Obstetric Complications and Transition to Psychosis in an ‘Ultra’ High Risk Sample

2005 ◽  
Vol 39 (6) ◽  
pp. 460-466 ◽  
Author(s):  
Yang Yun ◽  
Lisa J. Phillips ◽  
Sue Cotton ◽  
Alison R. Yung ◽  
Shona M. Francey ◽  
...  
Keyword(s):  
Risk Factor ◽  
High Risk ◽  
Psychotic Disorder ◽  
Psychotic Disorders ◽  
Functional Decline ◽  
Obstetric Complications ◽  
Psychotic Symptoms ◽  
Psychotic Episode ◽  
Degree Relative ◽  
Ultra High Risk

Objective: An association between birth and pregnancy complications and the later development of schizophrenia has been described for decades and obstetric complications (OCs) have been proposed as a vulnerability marker for psychosis in line with the neurodevelopmental hypothesis of psychotic disorders. Previous studies of OCs have focused on established schizophrenia. In this study, the association between OCs and the development of psychotic disorder was studied in a group of 74 young people identified as being at very high risk for the first onset of psychosis. Method: The ‘ultra’ high risk (UHR) cohort was identified by the presence of subthreshold psychotic symptoms, or a combination of first-degree relative with a psychotic disorder and recent functional decline. Thirty-eight per cent of the cohort developed an acute psychotic episode over the 12-month period after recruitment. As a component of a larger research study, the level of OCs experienced by the UHR cohort was assessed at intake. Results: Obstetric complicationswere not associated with the later development of psychosis in the UHR group included in this study. Conclusions: This study does not suppor t a role for OCs as a risk factorfor the later development of psychosis; however, we cannot conclude that they should be completely ignored as a candidate risk factor for onset of psychosis. A number of weaknesses of the study suggest that it may be premature to dismiss OCs as a risk factor for the development of psychosis and further research is urged in this area.

scholarly journals Longitudinal alterations in motivational salience processing in ultra-high-risk subjects for psychosis

2016 ◽  
Vol 47 (2) ◽  
pp. 243-254 ◽  
Author(s):  
A. Schmidt ◽  
M. Antoniades ◽  
P. Allen ◽  
A. Egerton ◽  
C. A. Chaddock ◽  
...  
Keyword(s):  
High Risk ◽  
Ventral Striatum ◽  
Psychotic Disorders ◽  
Irrelevant Stimulus ◽  
Psychotic Symptoms ◽  
Attribute Salience ◽  
Ultra High Risk ◽  
Stimulus Features ◽  
Task Irrelevant

BackgroundImpairments in the attribution of salience are thought to be fundamental to the development of psychotic symptoms and the onset of psychotic disorders. The aim of the present study was to explore longitudinal alterations in salience processing in ultra-high-risk subjects for psychosis.MethodA total of 23 ultra-high-risk subjects and 13 healthy controls underwent functional magnetic resonance imaging at two time points (mean interval of 17 months) while performing the Salience Attribution Test to assess neural responses to task-relevant (adaptive salience) and task-irrelevant (aberrant salience) stimulus features.ResultsAt presentation, high-risk subjects were less likely than controls to attribute salience to relevant features, and more likely to attribute salience to irrelevant stimulus features. These behavioural differences were no longer evident at follow-up. When attributing salience to relevant cue features, ultra-high-risk subjects showed less activation than controls in the ventral striatum at both baseline and follow-up. Within the high-risk sample, amelioration of abnormal beliefs over the follow-up period was correlated with an increase in right ventral striatum activation during the attribution of salience to relevant cue features.ConclusionsThese findings confirm that salience processing is perturbed in ultra-high-risk subjects for psychosis, that this is linked to alterations in ventral striatum function, and that clinical outcomes are related to longitudinal changes in ventral striatum function during salience processing.

scholarly journals Young people at ultra high risk for psychosis: research from the PACE clinic

2011 ◽  
Vol 33 (suppl 2) ◽  
pp. s143-s160 ◽  
Author(s):  
Alison R. Yung ◽  
Barnaby Nelson
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Psychotic Disorders ◽  
Omega 3 ◽  
Prodromal Phase ◽  
Risk Criteria ◽  
Current Controversy ◽  
Ultra High Risk ◽  
Risk Approach ◽  
Attenuated Psychosis Syndrome

Over the last fifteen years, attempts have been made to prospectively identify individuals in the prodromal phase of schizophrenia and other psychotic disorders. The ultra high risk approach, based on a combination of known trait and state risk factors, has been the main strategy used. The validation of the ultra high risk criteria allowed for predictive research in this population in an attempt to identify clinical, neurocognitive and neurobiological risk factors for psychosis onset. It also led to a series of intervention studies in this population, which have included the use of low dose antipsychotic medication, cognitive therapy, and omega-3 fatty acids. Although there is moderate evidence for the effectiveness of specific intervention strategies in this population, the most effective type and duration of intervention is yet to be determined. A current controversy in the field is whether to include an adaption of the ultra high risk criteria (the attenuated psychosis syndrome) in the next version of the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition).

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

2018 ◽  
Vol 21 (4) ◽  
pp. 131-133 ◽  
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.

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

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.

scholarly journals Development of Executive Functions as Reflected in Daily Life Behaviors in Young Adults at Ultra-High Risk for Psychosis: Associations With Symptoms and Functioning

2020 ◽  
Vol 1 (1) ◽  
Author(s):  
Louise Birkedal Glenthøj ◽  
Carsten Hjorthøj ◽  
Tina Dam Kristensen ◽  
Christina Wenneberg ◽  
Merete Nordentoft ◽  
...  
Keyword(s):  
High Risk ◽  
Executive Functions ◽  
Social Functioning ◽  
Clinical Symptoms ◽  
Daily Life ◽  
Real Life ◽  
Psychotic Symptoms ◽  
Ultra High Risk ◽  
Behaviour Rating

Abstract There is a paucity of evidence on executive functions (EF) as reflected in daily life behaviors in individuals at ultra-high risk (UHR) for psychosis. This prospective follow-up study investigated the 1-year development in EF in UHR compared to healthy controls (HC) and how this change may relate to change in severity of clinical symptoms, social communication, and functioning. UHR (N = 132) and HC (N = 66) were assessed with the Behaviour Rating Inventory of Executive Function–Adult version (BRIEF-A) self and informant report at baseline and 12 months follow-up comprising the Behavioral Regulation Index (BRI) and the Metacognition Index (MI). Additionally, data on depressive-, negative-, and attenuated psychotic symptoms and everyday social functioning were collected. The study found UHR to display large baseline impairments in EF in real life on both self- and informant reports. UHR and HC showed a significantly different development of EF over time, with UHR displaying greater improvements in EF compared to HC. Change in clinical symptoms did not relate to improvements in EF, except for depressive symptoms negatively associating with the development of the MI. Improvements on the BRI and MI were significantly associated with improvements in social functioning. Findings suggest the potential of UHR individuals displaying a larger ongoing maturational development of daily life EF than HC that seems predominantly independent of development of clinical symptoms. If replicated, this supports a maturational trajectory of daily life EF in UHR that approaches, but do not reach, the level of HC and may indicate a window of opportunity for targeted remediation approaches.

scholarly journals Gender Differences in Individuals at High-Risk of Psychosis: A Comprehensive Literature Review

2015 ◽  
Vol 2015 ◽  
pp. 1-13 ◽  
Author(s):  
Ana Barajas ◽  
Susana Ochoa ◽  
Jordi E. Obiols ◽  
Lluís Lalucat-Jo
Keyword(s):  
Gender Differences ◽  
High Risk ◽  
Social Functioning ◽  
Negative Symptoms ◽  
Psychotic Disorders ◽  
Control Variable ◽  
Prodromal Phase ◽  
Men And Women ◽  
Conversion Rates ◽  
High Risk Populations

Introduction. To date, few studies have focused on the characterization of clinical phenomenology regarding gender in population at high-risk of psychosis. This paper is an attempt to summarize the findings found in the scientific literature regarding gender differences in high-risk populations, taking into account parameters studied in populations with schizophrenia and other psychotic disorders, such as incidence, clinical expression, duration of untreated illness (DUI), social functioning, and cognitive impairment prior to full-blown psychosis development.Method. Studies were systematically searched in PubMed. Studies using gender variable as a control variable were excluded. 12 studies met inclusion criteria.Results. Most of the studies found a differential pattern between women and men as regards clinical, social, and cognitive variables in the prodromal phase, with worse performance in men except in cognitive functioning (more severe negative symptoms, worse social functioning, and longer DUI in men). Similar conversion rates over time were found between men and women.Conclusions. Many of the studies analyzed suggest that differences between men and women in the expression of psychosis extend across a continuum, from the subclinical forms of illness to the debut of psychosis. However, the small number of studies and their significant methodological and clinical limitations do not allow for firm conclusions.

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