Gary Brucato

The impact of emotion awareness and regulation on social functioning in individuals at clinical high risk for psychosis.

BACKGROUND Social functioning (SF) difficulties are ubiquitous among individuals at clinical high risk for psychosis (CHR), but it is not yet clear why. One possibility is suggested by the observation that effective SF requires adaptive emotion awareness and regulation. Previous reports have documented deficits in emotion awareness and regulation in individuals with schizophrenia, and have shown that such deficits predicted SF. However, it is unknown whether these deficits are present prior to the onset of psychosis or whether they are linked to SF in CHR individuals. METHOD We conducted a cross-sectional comparison of emotion awareness and regulation in 54 individuals at CHR, 87 with schizophrenia and 50 healthy controls (HC). Then, within the CHR group, we examined links between emotion awareness, emotion regulation and SF as indexed by the Global Functioning Scale: Social (Cornblatt et al. 2007). RESULTS Group comparisons indicated significant differences between HC and the two clinical groups in their ability to identify and describe feelings, as well as the use of suppression and reappraisal emotion-regulation strategies. Specifically, the CHR and schizophrenia groups displayed comparable deficits in all domains of emotion awareness and emotion regulation. A hierarchical multiple regression analysis indicated that difficulties describing feelings accounted for 23.2% of the SF variance. CONCLUSIONS The results indicate that CHR individuals display substantial emotion awareness and emotion-regulation deficits, at severity comparable with those observed in individuals with schizophrenia. Such deficits, in particular difficulties describing feelings, predate the onset of psychosis and contribute significantly to poor SF in this population.

Assessing suicidal ideation in individuals at clinical high risk for psychosis

BACKGROUND The majority of individuals with schizophrenia and other psychotic illnesses have had suicidal ideation at some point during the illness. However, little is known about the variation in level and intensity of suicidal ideation and symptoms in the attenuated stage of psychotic illness. Our aims were to assess prevalence of suicidal ideation in this at risk group, and to examine the severity and intensity of suicidal ideation, and their relation to symptoms. METHODS Suicidal ideation was assessed in 42 clinical high-risk participants using the Columbia Suicide Severity Rating Scale (C-SSRS). We hypothesized that prevalence rates would be similar to what was found in previous studies, and individuals with suicidal ideation would have higher positive and negative symptoms, with poorer functioning. We assessed levels of severity and intensity of suicidal ideation related to these symptoms, and examined how depressive symptoms affected these relationships. RESULTS Nearly half (42.9%) of participants reported having current suicidal ideation. We found no relationship to positive symptoms. However, severity and intensity of suicidal ideation were found to be related to negative symptoms and level of functioning. When controlling for depressive symptoms during exploratory analysis, this relationship still emerged. CONCLUSIONS This study adds to the literature demonstrating the complex nature of suicidal ideation in psychotic illness. The C-SSRS has shown to be helpful in determining relationships between severity and intensity in suicidal ideation in relation to specific symptoms in a research setting.

Baseline demographics, clinical features and predictors of conversion among 200 individuals in a longitudinal prospective psychosis-risk cohort

BACKGROUND DSM-5 proposes an Attenuated Psychosis Syndrome (APS) for further investigation, based upon the Attenuated Positive Symptom Syndrome (APSS) in the Structured Interview for Psychosis-Risk Syndromes (SIPS). SIPS Unusual Thought Content, Disorganized Communication and Total Disorganization scores predicted progression to psychosis in a 2015 NAPLS-2 Consortium report. We sought to independently replicate this in a large single-site high-risk cohort, and identify baseline demographic and clinical predictors beyond current APS/APSS criteria. METHOD We prospectively studied 200 participants meeting criteria for both the SIPS APSS and DSM-5 APS. SIPS scores, demographics, family history of psychosis, DSM Axis-I diagnoses, schizotypy, and social and role functioning were assessed at baseline, with follow-up every 3 months for 2 years. RESULTS The conversion rate was 30% (n = 60), or 37.7% excluding participants who were followed under 2 years. This rate was stable across time. Conversion time averaged 7.97 months for 60% who developed schizophrenia and 15.68 for other psychoses. Mean conversion age was 20.3 for males and 23.5 for females. Attenuated odd ideas and thought disorder appear to be the positive symptoms which best predict psychosis in a logistic regression. Total negative symptom score, Asian/Pacific Islander and Black/African-American race were also predictive. As no Axis-I diagnosis or schizotypy predicted conversion, the APS is supported as a distinct syndrome. In addition, cannabis use disorder did not increase risk of conversion to psychosis. CONCLUSIONS NAPLS SIPS findings were replicated while controlling for clinical and demographic factors, strongly supporting the validity of the SIPS APSS and DSM-5 APS diagnosis.

Various neurocognitive deficits and conversion risk in individuals at clinical high risk for psychosis

Individuals at clinical high risk for psychosis (CHR) exhibit neurocognitive deficits in multiple domains. The aim of this study is to investigate whether several components of neurocognition are predictive of conversion to psychosis.

Sleep disturbances in individuals at clinical high risk for psychosis

There has been recent interest in understanding the role that sleep disturbance plays in patients at Clinical High Risk for psychosis (CHR). We assessed sleep disturbance in 194 CHR patients and 66 healthy control subjects and their relationship to symptoms (positive, negative and general functioning). Patients experienced significantly more sleep disturbance than healthy control subjects and their sleep disturbance was related to greater positive and negative symptoms and worse overall functioning. Targeting sleep disturbance in CHR individuals may provide alternative means of treating the CHR syndrome.

Neural Dysfunction in Cognitive Control Circuits in Persons at Clinical High-Risk for Psychosis

Cognitive control, a set of functions that develop throughout adolescence, is important in the pathogenesis of psychotic disorders. Whether cognitive control has a role in conferring vulnerability for the development of psychotic illness is still unknown. The aim of this study was to investigate the neural systems supporting cognitive control in individuals deemed to be potentially prodromal for psychotic illness. We recruited 56 participants at clinical high-risk (CHR) for psychosis based on the Structured Interview for Psychosis-Risk Syndromes (SIPS) and 49 healthy controls. Twelve of the CHR participants eventually developed psychosis. We compared functional magnetic resonance imaging (fMRI) BOLD signal during the performance of the Simon task. We tested for differences between CHR individuals and controls in conflict-related functional activity. In the CHR group when compared with controls, we detected smaller conflict-related activations in several cortical areas, including the Dorsolateral Prefrontal Cortex (DLPFC). Furthermore, conflict-related activations in the DLPFC of those CHR individuals who ultimately developed psychosis (CHR converters) were smaller than in non-converters (CHR non-converters). Higher levels of conflict-related activation were associated with better social and role outcome. Risk for psychosis was associated at the neural level with reduced conflict-related brain activity. This neural phenotype appears correlated within the DLPFC with the development of psychosis and with functional outcome.

Impact of lifetime traumatic experiences on suicidality and likelihood of conversion in a cohort of individuals at clinical high-risk for psychosis

Recent research suggests that trauma history (TH) is a strong socio-environmental risk factor for the development of psychosis. While reported rates of childhood trauma are higher among individuals at clinical high-risk (CHR) for psychosis than in the general population, little research has explored the effects of trauma upon the severity of attenuated positive symptoms. We aimed to explore the specific relationships between TH and baseline symptom severity; likelihood of conversion to full-blown psychosis; suicidal ideation (SI); and suicidal behavior (SB) in a cohort of 200 help-seeking CHR individuals. Participants were evaluated every three months for up to two years using the Structured Interview for Psychosis-Risk Syndromes (SIPS). More trauma history was reported by females and Hispanic/Latino participants, while age and race did not significantly distinguish those with and without TH. Individuals with TH reported higher rates of SI and SB than those without. While TH was positively associated with several SIPS subscales, including Unusual Thought Content, Perceptual Abnormalities/Hallucinations, Bizarre Thinking, Sleep Disturbances, and Dysphoric Mood, and negatively associated with Expressed Emotion, results indicated that TH was not significantly related to conversion to psychosis. Moreover, baseline SI was unrelated to conversion and baseline DSM diagnosis, with the exception of Post-Traumatic Stress Disorder (PTSD). These results suggest that traumatic experiences may significantly impact the severity of attenuated positive symptoms and suicidality in the CHR state, providing new windows for further research and potential intervention.

Distinct Relationships Between Visual and Auditory Perceptual Abnormalities and Conversion to Psychosis in a Clinical High-Risk Population

Distinct Relationships Between Visual and Auditory Perceptual Abnormalities and Conversion to Psychosis in a Clinical High-Risk Population Hallucinations are a ubiquitous symptom experienced across psychotic disorders. This symptom, particularly in its auditory form, is widely thought to share a common substrate with other positive symptoms.1 However, only unusual thought content and thought disorganization, not perceptual abnormalities (eg, hyperacusis, illusions, and momentary hallucinations), are associated with conversion to psychosis in clinical high-risk (CHR) populations,2,3 despite the high incidence of perceptual abnormalities.2 Importantly, although the frequencies of auditory and visual perceptual abnormalities in CHR individuals are similar,4 differences in the prevalence of auditory and visual hallucinations in full psychosis5 may suggest distinct neurobiological substrates. Therefore, we hypothesized that auditory and visual perceptual abnormalities would have distinct clinical correlates in CHR individuals.

A Longitudinal Study of Violent Behavior in a Psychosis-Risk Cohort

There is a lack of insight into the relationships between violent ideation, violent behavior, and early, particularly attenuated, psychosis. Our aims were to examine the relationships between baseline violent behavior and violent ideation and outcome violent behavior and conversion to psychosis in at-risk individuals. We longitudinally assessed 200 individuals at clinical high risk for psychosis for violent ideation and violent behavior using the Structured Interview for Psychosis-Risk Syndromes (SIPS), and rated these according to MacArthur Community Violence categories. Fifty-six individuals (28%) reported violent ideation at baseline, 12 (6%) reported violent behavior within 6 months pre-baseline, and 8 (4%) committed acts of violence during the follow-up time period. Information about violent ideation was obtained only by indirect, but not direct, inquiry about violent ideation. Both violent ideation and violent behavior at baseline significantly predicted violent behavior (RR=13.9, p=0.001; RR=8.3, p=0.003, respectively) during follow-up, as well as a diagnosis of psychosis (RR=2.3 and 2.4, respectively; both p<0.001), independent of more than 40 clinical and demographic variables. The targets of the subjects’ violent ideation at baseline were completely different than their subsequent targets of violent behavior. Violent behavior occurred within 7 days (SD 35 days) of a diagnosis of syndromal psychosis. These data suggest that checking carefully for violent ideation and behavior in clinical high-risk patients is essential, as these have predictive value for conversion to psychosis and likelihood of violence in the future.

Exploring the Relationship Between Body Mass Index and Positive Symptom Severity in Persons at Clinical High Risk for Psychosis

Abstract Metabolic health and positive symptom severity has been investigated in schizophrenia, but not in clinical high risk (CHR) patients. We hypothesized that greater body mass index (BMI) in CHR patients would be related to less positive symptoms. We examined this relationship in CHR patients being treated with 1) no psychotropic medications (n = 58), 2) an antipsychotic (n = 14), or 3) an antidepressant without an antipsychotic (n = 10). We found no relationship between BMI and positive symptoms in unmedicated CHR patients, the majority of whom had a narrow BMI range between 20 and 30. However, in the smaller sample of CHR patients taking an antidepressant or antipsychotic, BMI was negatively correlated with positive symptoms. Although potentially underpowered, these preliminary findings provide initial steps in elucidating the relationships between metabolic health, neurochemistry, and symptom severity in CHR patients.