Jean Addington

Prediction of Psychosis in Youth at High Clinical Risk: A Multisite Longitudinal Study in North America

CONTEXT Early detection and prospective evaluation of individuals who will develop schizophrenia or other psychotic disorders are critical to efforts to isolate mechanisms underlying psychosis onset and to the testing of preventive interventions, but existing risk prediction approaches have achieved only modest predictive accuracy. OBJECTIVES To determine the risk of conversion to psychosis and to evaluate a set of prediction algorithms maximizing positive predictive power in a clinical high-risk sample. DESIGN, SETTING, AND PARTICIPANTS Longitudinal study with a 2 1/2-year follow-up of 291 prospectively identified treatment-seeking patients meeting Structured Interview for Prodromal Syndromes criteria. The patients were recruited and underwent evaluation across 8 clinical research centers as part of the North American Prodrome Longitudinal Study. MAIN OUTCOME MEASURE Time to conversion to a fully psychotic form of mental illness. RESULTS The risk of conversion to psychosis was 35%, with a decelerating rate of transition during the 2 1/2-year follow-up. Five features assessed at baseline contributed uniquely to the prediction of psychosis: a genetic risk for schizophrenia with recent deterioration in functioning, higher levels of unusual thought content, higher levels of suspicion/paranoia, greater social impairment, and a history of substance abuse. Prediction algorithms combining 2 or 3 of these variables resulted in dramatic increases in positive predictive power (ie, 68%-80%) compared with the prodromal criteria alone. CONCLUSIONS These findings demonstrate that prospective ascertainment of individuals at risk for psychosis is feasible, with a level of predictive accuracy comparable to that in other areas of preventive medicine. They provide a benchmark for the rate and shape of the psychosis risk function against which standardized preventive intervention programs can be compared.

The Psychosis High-Risk State A Comprehensive State-of-the-Art Review

CONTEXT During the past 2 decades, a major transition in the clinical characterization of psychotic disorders has occurred. The construct of a clinical high-risk (HR) state for psychosis has evolved to capture the prepsychotic phase, describing people presenting with potentially prodromal symptoms. The importance of this HR state has been increasingly recognized to such an extent that a new syndrome is being considered as a diagnostic category in the DSM-5. OBJECTIVE To reframe the HR state in a comprehensive state-of-the-art review on the progress that has been made while also recognizing the challenges that remain. DATA SOURCES Available HR research of the past 20 years from PubMed, books, meetings, abstracts, and international conferences. STUDY SELECTION AND DATA EXTRACTION Critical review of HR studies addressing historical development, inclusion criteria, epidemiologic research, transition criteria, outcomes, clinical and functional characteristics, neurocognition, neuroimaging, predictors of psychosis development, treatment trials, socioeconomic aspects, nosography, and future challenges in the field. DATA SYNTHESIS Relevant articles retrieved in the literature search were discussed by a large group of leading worldwide experts in the field. The core results are presented after consensus and are summarized in illustrative tables and figures. CONCLUSIONS The relatively new field of HR research in psychosis is exciting. It has the potential to shed light on the development of major psychotic disorders and to alter their course. It also provides a rationale for service provision to those in need of help who could not previously access it and the possibility of changing trajectories for those with vulnerability to psychotic illnesses.

Reliability and validity of a depression rating scale for schizophrenics

The Calgary Depression Scale (CDS) is a nine item structured interview scale, in which each item has a four point measure, each point anchored by descriptors. The scale has been specifically developed to assess depression in schizophrenics. This article describes the testing of the reliability and validity of the CDS. The scale is assessed and compared to three established measures, the Hamilton Depression Rating Scale (HDRS) the Beck Depression Inventory (BDI) and a depression measure derived from the Brief Psychiatric Rating Scale (BPRS). Confirmatory factor analysis demonstrated that the CDS is unidimensional, measuring the same construct in both in- and outpatients. The scale has high internal consistency, significant strong correlations with scores on the Hamilton, Beck and BPRS depression measures, and the presence of a major depressive episode. All items of the CDS significantly discriminate between the presence and absence of a major depressive episode. It is concluded that the CDS is a parsimonious reliable scale which is suitable for assessing depression across both the acute and residual stages of schizophrenia.

Facial affect recognition and information processing in schizophrenia and bipolar disorder

This study assessed facial affect recognition and visual attention in a sample of 40 individuals with schizophrenia, at hospitalization and 3 months later during an out-patient phase of relative remission. Secondly, at the out-patient phase the performance of the individuals with schizophrenia on tasks of visual attention, facial affect recognition and facial recognition was compared to the performances of a non-psychiatric control group and a bipolar group on these tasks. Attention was measured with the Continuous Performance Test and the Span of Apprehension task. Facial affect recognition was measured with a discrimination task and an identification task. A measure of facial recognition was also used. The schizophrenia patients performed more poorly on measures of facial affect recognition and facial recognition than both control groups. Despite a significant improvement in symptoms over time, there was no change in facial affect recognition for the schizophrenia subjects. For the schizophrenia subjects there were significant associations between attention tasks and the facial tasks. These results suggest that for individuals with schizophrenia, deficits in facial affect recognition are stable deficits that are related to other impairments in neurocognition. This has implications for psychosocial treatments.

Medication adherence of individuals with a first episode of psychosis

Objective:  To determine rates of adherence to antipsychotic medication in first episode patients and the correlates of adherence in this group.

Facial affect recognition: A mediator between cognitive and social functioning in psychosis?

BACKGROUND Facial affect recognition has been implicated in the relationship between cognition and social functioning. This 1-year longitudinal study tested the hypothesis that facial affect recognition mediates the relationship between cognitive and social functioning. METHOD Three groups were included: 50 first-episode of psychosis (FE) subjects, 53 multi-episode schizophrenia subjects (ME) and 55 non-psychiatric controls (NPC). Subjects were assessed on two facial affect recognition tasks, a comprehensive cognitive battery and a measure of social functioning. FE subjects were assessed on admission to a comprehensive FE program and 1 year later. The ME and NPC groups had two assessments 1 year apart. RESULTS Both the FE and ME subjects were clearly impaired relative to NPCs in cognition, social functioning and facial affect recognition. There were significant associations among facial affect recognition, cognition and social functioning in all three groups. For ME and FE subjects, but not NPCs, there was evidence that facial affect recognition did partially mediate the relationship between cognitive and social functioning. CONCLUSION This study provides some first steps in understanding the complex relationship between cognition and outcome and has potential implications for the design of remediation strategies.

At Clinical High Risk for Psychosis: Outcome for Nonconverters

OBJECTIVE A major focus of early intervention research is determining the risk of conversion to psychosis and developing optimal algorithms of prediction. Although reported rates of nonconversion vary in the literature, the nonconversion rate always encompasses a majority (50%-85%) of the sample participants. Less is known about the outcome among this group, referred to as false positive individuals. METHOD A longitudinal study was conducted of more than 300 prospectively identified treatment-seeking individuals meeting criteria for a psychosis-risk syndrome. Participants were recruited and evaluated across eight clinical research centers as part of the North American Prodrome Longitudinal Study. Over a 2.5-year follow-up assessment period, 214 (71%) participants had not made the transition to psychosis. RESULTS The sample examined included 111 individuals who had at least 1 year of follow-up data available and did not transition to psychosis within the study duration. In year 1, there was significant improvement in ratings for attenuated positive and negative symptoms. However, at least one attenuated positive symptom was still present for 43% of the sample at 1 year and for 41% at 2 years. At the follow-up timepoints, social and role functioning were significantly poorer in the clinical sample relative to nonpsychiatric comparison subjects. CONCLUSIONS Help-seeking individuals who meet prodromal criteria appear to represent those who are truly at risk for psychosis and are showing the first signs of illness, those who remit in terms of the symptoms used to index clinical high-risk status, and those who continue to have attenuated positive symptoms.

Neurocognitive and social functioning in schizophrenia: a 2.5 year follow-up study

In our previous study we demonstrated that, in 80 schizophrenia subjects, verbal ability, verbal memory and executive functioning were significantly associated with social problem solving. The objective of this present study was to assess the longitudinal stability of the relationship between social and neurocognitive functioning in schizophrenia. This 2.5 year longitudinal cohort study re-assessed community functioning, social problem solving and symptoms in 65 of the 80 original subjects to determine the predictive ability of neurocognitive functioning. Neurocognition was not re-assessed at this follow-up. Positive and negative symptoms were assessed with the Positive and Negative Syndrome Scale. Social functioning was assessed using the Social Functioning Scale, the Quality of Life Scale, and the Assessment of Interpersonal Problem-Solving Skills (AIPSS). Verbal ability, verbal memory and vigilance were significant predictors of social problem solving as assessed by the AIPSS. Results suggest that the association between neurocognition and social functioning remains consistent over time.

Specificity of the Calgary Depression Scale for schizophrenics

This study sought to determine the specificity of the Calgary Depression Scale (CDS), a depression rating scale for schizophrenics. The specificity is the degree to which the scale assesses depression rather than negative or extrapyramidal symptoms. Subjects were 100 outpatients (OP) and 50 inpatients (IP) meeting DSM-III-R criteria for schizophrenia. Negative symptoms were assessed with the Positive and Negative Syndrome Scale (PANSS); extrapyramidal symptoms were assessed with the Simpson Angus Scale (SA) and depression with the CDS. Results were that the CDS showed no correlation with SA, but weak (0.33) statistically significant correlations with the PANSS negative symptom score in inpatients but not outpatients. Confirmatory factor analysis using Lisrel 6.0 showed that the model hypothesizing specificity of depression, negative symptoms and extrapyramidal symptoms, was significant, with a goodness of fit index of 0.89 and a root mean square residual of 0.07. It is concluded that the CDS achieves a useful degree of separation between measures of depression, negative and extrapyramidal symptoms in subjects with schizophrenia, when combined with the other measures used in this study.

The psychological well-being of family members of individuals with schizophrenia

Abstract  Background: The purpose of the study was to attempt to understand the experience of family members of individuals with schizophrenia. More specifically, we wanted to determine whether a measure of caregiving would be a stronger predictor of the psychological well-being of families who have a member with schizophrenia than a measure of burden. Method: Forty-one family members of 30 individuals with schizophrenia were recruited. A measure of burden, a measure of the experience of caregiving, and the duration of the illness were used to determine the best predictor of psychological well-being. Results: Regression analyses indicated that the strongest predictor of psychological well-being was the negative scale of the Experience of Caregiving Inventory (ECI). There was also a significant relationship between poor psychological well-being and short duration of illness. Conclusions: The findings of the study indicated that family members are significantly distressed as a result of having a family member with schizophrenia. There is support for using newer scales, like the ECI. Furthermore, increased family support is required in the early stages of the illness.