scholarly journals Defense Mechanisms in Adolescents at High Risk of Developing Psychosis: An Empirical Investigation

2020 ◽  
Vol 23 (1) ◽  
Author(s):  
Tommaso Boldrini ◽  
Gabriele Lo Buglio ◽  
Guido Giovanardi ◽  
Vittorio Lingiardi ◽  
Silvia Salcuni
Keyword(s):  
At Risk ◽  
High Risk ◽  
Defense Mechanisms ◽  
Rating Scales ◽  
Defense Mechanism ◽  
Psychotic Symptoms ◽  
Ultra High Risk ◽  
Risk Patients ◽  
Not At Risk ◽  
The Relationship

Research within psychotherapy and psychopathology frameworks has been inspired by the central concept of defense mechanisms, which play a pivotal role in psychoanalysis. Defense specificities have only recently been studied systematically in the context of several clinical diagnoses. The present study aimed to explore the specificities of defense mechanisms in adolescents at ultra-high risk of developing psychosis and test the relationship between defensive functioning and attenuated psychotic symptoms. Twenty-six adolescent inpatients at ultra-high risk of developing psychosis and a matched clinical control group of inpatients not at risk of psychosis were interviewed. Two observer-rater methods, the Defense Mechanism Rating Scales and the Psychotic-Defense Mechanism Rating Scales were applied to interview transcripts to assess the individual use of defenses. Ultra-high-risk patients demonstrated lower defense mechanisms (i.e., total instances of defense mechanisms observed) and lower overall adaptiveness of the defenses presented. When specific differences between groups were observed, psychotic defenses were the sole defenses that could partially discriminate between ultra-high-risk and not at-risk patients. Regarding the relationship between defense mechanisms and subthreshold psychotic symptoms, psychotic defenses were associated with negative and disorganization symptoms, rather than with positive symptoms. The psychological vulnerability of ultra-high-risk patients is discussed and treatment implications for psychotherapy with such challenging patients are addressed.

scholarly journals The reality of at risk mental state services: a response to recent criticisms

2019 ◽  
pp. 1-7 ◽  
Author(s):  
Alison R. Yung ◽  
Stephen J. Wood ◽  
Ashok Malla ◽  
Barnaby Nelson ◽  
Patrick McGorry ◽  
...  
Keyword(s):  
At Risk ◽  
High Risk ◽  
Psychotic Disorder ◽  
Mental State ◽  
Help Seeking ◽  
Psychotic Symptoms ◽  
Ultra High Risk ◽  
Psychological Medicine ◽  
Poor Outcomes ◽  
At Risk Mental State

AbstractBackgroundIn the 1990s criteria were developed to detect individuals at high and imminent risk of developing a psychotic disorder. These are known as the at risk mental state, ultra high risk or clinical high risk criteria. Individuals meeting these criteria are symptomatic and help-seeking. Services for such individuals are now found worldwide. Recently Psychological Medicine published two articles that criticise these services and suggest that they should be dismantled or restructured. One paper also provides recommendations on how ARMS services should be operate.MethodsIn this paper we draw on the existing literature in the field and present the perspective of some ARMS clinicians and researchers.ResultsMany of the critics' arguments are refuted. Most of the recommendations included in the Moritz et al. paper are already occurring.ConclusionsARMS services provide management of current problems, treatment to reduce risk of onset of psychotic disorder and monitoring of mental state, including attenuated psychotic symptoms. These symptoms are associated with a range of poor outcomes. It is important to assess them and track their trajectory over time. A new approach to detection of ARMS individuals can be considered that harnesses broad youth mental health services, such as headspace in Australia, Jigsaw in Ireland and ACCESS Open Minds in Canada. Attention should also be paid to the physical health of ARMS individuals. Far from needing to be dismantled we feel that the ARMS approach has much to offer to improve the health of young people.

scholarly journals Relationship Between Cognitive and Clinical Insight at Different Durations of Untreated Attenuated Psychotic Symptoms in High-Risk Individuals at Risk

2021 ◽  
Vol 12 ◽  
Author(s):  
LiHua Xu ◽  
Mei Zhang ◽  
ShuQing Wang ◽  
YanYan Wei ◽  
HuiRu Cui ◽  
...  
Keyword(s):  
At Risk ◽  
High Risk ◽  
Power Analysis ◽  
Significant Positive Correlation ◽  
Composite Index ◽  
Structured Interview ◽  
Psychotic Symptoms ◽  
Cognitive Insight ◽  
Healthy Control ◽  
The Relationship

Background: This study examines whether cognitive insight is impaired in high-risk individuals with attenuated psychotic symptoms (APS) and explores the relationship between cognitive and clinical insight at different durations of untreated attenuated psychotic symptoms (DUAPS).Methods: The Structured Interview for Psychosis high-risk Syndrome (SIPS) was used to identify APS individuals. APS (n = 121) and healthy control (HC, n = 87) subjects were asked to complete the Beck Cognitive Insight Scale (BCIS). Clinical insight of APS individuals was evaluated using the Schedule for Assessment of Insight (SAI). APS individuals were classified into four subgroups based on DUAPS, including 0–3, 4–6, 7–12, and >12 months. Power analysis for significant correlation was conducted using the WebPower package in R.Results: Compared with HC subjects, APS individuals showed poorer cognitive insight, with lower scores on BCIS self-reflectiveness and composite index (BCIS self-reflectiveness minus BCIS self-certainty). Only when DUAPS was longer than 12 months did the significant positive correlation between cognitive and clinical insight obtain the power about 0.8, including the associations between self-reflectiveness and awareness of illness, self-reflectiveness and the total clinical insight, and composite index and awareness of illness. The positive associations of composite index with awareness of illness within 0–3 months DUAPS and with the total score of SAI when DUAPS > 12 months were significant but failed to obtain satisfactory power.Conclusions: APS individuals may have impaired cognitive insight, demonstrating lower self-reflectiveness. The correlation between cognitive and clinical insight is associated with the duration of untreated attenuated psychotic symptoms.

scholarly journals Altered activation and connectivity in a hippocampal–basal ganglia–midbrain circuit during salience processing in subjects at ultra high risk for psychosis

2017 ◽  
Vol 7 (10) ◽  
pp. e1245-e1245 ◽  
Author(s):  
T Winton-Brown ◽  
A Schmidt ◽  
J P Roiser ◽  
O D Howes ◽  
A Egerton ◽  
...  
Keyword(s):  
Basal Ganglia ◽  
High Risk ◽  
Ventral Striatum ◽  
Effective Connectivity ◽  
Psychotic Symptoms ◽  
Neural Responses ◽  
Hippocampal Activity ◽  
Ultra High Risk ◽  
Aberrant Salience ◽  
The Relationship

Abstract Animal models of psychosis propose that abnormal hippocampal activity drives increased subcortical dopamine function, which is thought to contribute to aberrant salience processing and psychotic symptoms. These effects appear to be mediated through connections between the hippocampus, ventral striatum/pallidum and the midbrain. The aim of the present study was to examine the activity and connectivity in this pathway in people at ultra high risk (UHR) for psychosis. Functional magnetic resonance imaging was used to compare neural responses in a hippocampal–basal ganglia–midbrain network during reward, novelty and aversion processing between 29 UHR subjects and 32 healthy controls. We then investigated whether effective connectivity within this network is perturbed in UHR subjects, using dynamic causal modelling (DCM). Finally, we examined the relationship between alterations in activation and connectivity in the UHR subjects and the severity of their psychotic symptoms. During reward anticipation, UHR subjects showed greater activation than controls in the ventral pallidum bilaterally. There were no differences in activation during novelty or aversion processing. DCM revealed that reward-induced modulation of connectivity from the ventral striatum/pallidum to the midbrain was greater in UHR subjects than controls, and that in UHR subjects, the strength of connectivity in this pathway was correlated with the severity of their abnormal beliefs. In conclusion, ventral striatal/pallidal function is altered in people at UHR for psychosis and this is related to the level of their psychotic symptoms.

P.389 Baseline cortisol, psychotic symptoms and clinical outcome after one year in ultra high-risk patients

2019 ◽  
Vol 29 ◽  
pp. S275-S276
Author(s):  
D. Nordholm ◽  
C. Hjorthøj ◽  
V. Mondelli ◽  
K. Krakauer ◽  
L. Randers ◽  
...  
Keyword(s):  
High Risk ◽  
Clinical Outcome ◽  
Psychotic Symptoms ◽  
High Risk Patients ◽  
Baseline Cortisol ◽  
Ultra High Risk ◽  
Risk Patients ◽  
One Year

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 Interactions between hippocampal activity and striatal dopamine in people at clinical high risk for psychosis: relationship to adverse outcomes

2021 ◽  
Author(s):  
Gemma Modinos ◽  
Anja Richter ◽  
Alice Egerton ◽  
Ilaria Bonoldi ◽  
Matilda Azis ◽  
...  
Keyword(s):  
High Risk ◽  
Functional Outcomes ◽  
Mental States ◽  
Adverse Outcomes ◽  
Striatal Dopamine ◽  
Psychotic Symptoms ◽  
Dopamine Synthesis ◽  
Clinical High Risk ◽  
Hippocampal Activity ◽  
The Relationship

AbstractPreclinical models propose that increased hippocampal activity drives subcortical dopaminergic dysfunction and leads to psychosis-like symptoms and behaviors. Here, we used multimodal neuroimaging to examine the relationship between hippocampal regional cerebral blood flow (rCBF) and striatal dopamine synthesis capacity in people at clinical high risk (CHR) for psychosis and investigated its association with subsequent clinical and functional outcomes. Ninety-five participants (67 CHR and 28 healthy controls) underwent arterial spin labeling MRI and 18F-DOPA PET imaging at baseline. CHR participants were followed up for a median of 15 months to determine functional outcomes with the global assessment of function (GAF) scale and clinical outcomes using the comprehensive assessment of at-risk mental states (CAARMS). CHR participants with poor functional outcomes (follow-up GAF < 65, n = 25) showed higher rCBF in the right hippocampus compared to CHRs with good functional outcomes (GAF ≥ 65, n = 25) (pfwe = 0.026). The relationship between rCBF in this right hippocampal region and striatal dopamine synthesis capacity was also significantly different between groups (pfwe = 0.035); the association was negative in CHR with poor outcomes (pfwe = 0.012), but non-significant in CHR with good outcomes. Furthermore, the correlation between right hippocampal rCBF and striatal dopamine function predicted a longitudinal increase in the severity of positive psychotic symptoms within the total CHR group (p = 0.041). There were no differences in rCBF, dopamine, or their associations in the total CHR group relative to controls. These findings indicate that altered interactions between the hippocampus and the subcortical dopamine system are implicated in the pathophysiology of adverse outcomes in the CHR state.

Peripheral levels of superoxide dismutase and glutathione peroxidase in youths in ultra-high risk for psychosis: a pilot study

CNS Spectrums ◽  
2017 ◽  
Vol 24 (03) ◽  
pp. 333-337 ◽  
Author(s):  
Maiara Zeni-Graiff ◽  
Adiel C. Rios ◽  
Pawan K. Maurya ◽  
Lucas B. Rizzo ◽  
Sumit Sethi ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
At Risk ◽  
Superoxide Dismutase ◽  
High Risk ◽  
Glutathione Peroxidase ◽  
Healthy Control Group ◽  
Enzyme Linked Immunosorbent Assay ◽  
Control Group ◽  
Ultra High Risk ◽  
Healthy Control

IntroductionOxidative stress has been documented in chronic schizophrenia and in the first episode of psychosis, but there are very little data on oxidative stress prior to the disease onset.ObjectiveThis work aimed to compare serum levels of superoxide dismutase (SOD) and glutathione peroxidase (GPx) in young individuals at ultra-high risk (UHR) of developing psychosis with a comparison healthy control group (HC).MethodsThirteen UHR subjects and 29 age- and sex-matched healthy controls (HC) were enrolled in this study. Clinical assessment included the Comprehensive Assessment of At-Risk Mental States (CAARMS), the Semi-Structured Clinical Interview for DSM-IV Axis-I (SCID-I) or the Kiddie-SADS-Present and Lifetime Version (K-SADS-PL), and the Global Assessment of Functioning (GAF) scale. Activities of SOD and GPx were measured in serum by the spectrophotometric method using enzyme-linked immunosorbent assay kits.ResultsAfter adjusting for age and years of education, there was a significant lower activity of SOD and lower GPX activity in the UHR group compared to the healthy control group (rate ratio [RR]=0.330, 95% CI 0.187; 0.584, p&lt;0.001 and RR=0.509, 95% CI 0.323; 0.803, p=0.004, respectively). There were also positive correlations between GAF functioning scores and GPx and SOD activities.ConclusionOur results suggest that oxidative imbalances could be present prior to the onset of full-blown psychosis, including in at-risk stages. Future studies should replicate and expand these results.

scholarly journals Beyond the mask of deference: exploring the relationship between ruptures and transference in a single-case study

2016 ◽  
Vol 19 (2) ◽  
Author(s):  
Francesca Locati ◽  
Pietro De Carli ◽  
Emanuele Tarasconi ◽  
Margherita Lang ◽  
Laura Parolin
Keyword(s):  
Sequential Analysis ◽  
Rating Scales ◽  
Rating Scale ◽  
Defense Mechanism ◽  
Single Case ◽  
Assessment Procedure ◽  
Single Case Study ◽  
Alliance Ruptures ◽  
The Relationship

The relationship between transference and therapeutic alliance has been long discussed. It is only recently, however, that empirical evidence has provided support for a tight correspondence between several transference dimensions and rupture and resolution processes. In the present single-case study, we used alliance ruptures as a key dimension to understand patient’s transference dynamics. This was achieved in a particular form of patient’s behavior, i.e., patient’s deference and acquiescent behavior, which describes a significant submission to assertions, skills, judgments and point of views of another person. Therapeutic process was measured by means of the Rupture Resolution Rating Scale, the Core Conflictual Relationship Theme and the Defense Mechanism Rating Scales, whereas therapeutic outcome was measured by means of the Shedler-Westen Assessment Procedure-200. Results of sequential analysis yielded a significant correspondence between rupture markers, characterized by avoidance and shifting of session’s topic, and patient’s narrations. Furthermore, a systematic correspondence between alliance ruptures and patient’s avoidant functioning, which emerged both in transference relationship and in the quality of the defense structure, was found. Together, these findings indicate that patient’s deference inhibits the expression of relational themes, with ruptures in alliance that seem to be supported by a strong defensive structure. In particular, patient’s avoidance played a double role in the treatment. On the one hand, avoidance was the main characteristic of her transference structure, based on extreme intellectualization and emotional closure. On the other hand, it contributed to create an impasse in the treatment, based on a withdrawal ruptures model and on obsessive level defences.

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