Rahel Pearson

Psychosis risk screening with the Prodromal Questionnaire--brief version (PQ-B).

In this study, we examined the preliminary concurrent validity of a brief version of the Prodromal Questionnaire (PQ-B), a self-report screening measure for psychosis risk syndromes. Adolescents and young adults (N=141) who presented consecutively for clinical assessment to one of two early psychosis research clinics at the University of California, San Francisco and UC Los Angeles completed the PQ-B and the Structured Interview for Prodromal Syndromes (SIPS) at intake. Endorsement of three or more positive symptoms on the PQ-B differentiated between those with prodromal syndrome and psychotic syndrome diagnoses on the SIPS versus those with no SIPS diagnoses with 89% sensitivity, 58% specificity, and a positive Likelihood Ratio of 2.12. A Distress Score measuring the distress or impairment associated with endorsed positive symptoms increased the specificity to 68%, while retaining similar sensitivity of 88%. Agreement was very similar when participants with psychotic syndromes were excluded from the analyses. These results suggest that the PQ-B may be used as an effective, efficient self-report screen for prodromal psychosis syndromes when followed by diagnostic interview, in a two-stage evaluation process in help-seeking populations.

Environmental Risk and Protective Factors and Their Influence on the Emergence of Psychosis

Environmental risk and protective factors in schizophrenia play a significant role in the development and course of the disorder. The following article reviews the current state of evidence linking a variety of environmental factors and their impact on the emergence of psychotic disorders. The environmental factors include pre- and perinatal insults, stress and trauma, family environment, and cannabis use. The review of evidence is followed by case examples and clinical applications to facilitate the integration of the evidence into clinical practice.

Effectiveness of an internet intervention (Deprexis) for depression in a United States adult sample: A parallel-group pragmatic randomized controlled trial.

Objective: To examine the effectiveness of an Internet intervention for depression with a randomized, controlled trial in a large sample of adults recruited from the United States. Method: The current study examines the effectiveness of Deprexis, an Internet treatment for depression that was provided with relatively minimal support. There were 376 treatment-seeking adults (mean age = 32 years; 74% female; 77% Caucasian, 7% Asian, 7% multiple races, 4% African American, and 11% Hispanic/Latino) with elevated depression (Quick Inventory of Depressive Symptoms-Self-Report [QIDS-SR] > = 10) who were randomized to receive an 8-week course of treatment immediately (n = 285) or after an 8-week delay (n = 91; i.e., waitlist control). Results: Intention-to-treat analyses indicated that treatment was associated with greater reduction in self-reported symptoms of depression (effect size d = .80) and 12 times greater likelihood of experiencing at least 50% symptom improvement compared with waitlist control. Similar effects were observed for several secondary outcomes, such as interviewer-rated depression symptoms, well-being, and depression-related disability. Treatment effects for symptoms of social anxiety, panic, and traumatic intrusions were relatively small. Conclusion: Results suggest that Deprexis can produce symptomatic improvement among depressed adults recruited from the United States. Additional research is needed that examines whether improvements are maintained over time and who is particularly likely to respond to this form of treatment.

Serotonin Promoter Polymorphism (5-HTTLPR) Predicts Biased Attention for Emotion Stimuli Preliminary Evidence of Moderation by the Social Environment

A number of studies have found an association between attentional bias for negative stimuli and variation in the serotonin transporter promoter region polymorphism (5-HTTLPR). The current project examined whether a positive social environment mitigates this association. More specifically, we examined the relationship among attentional bias on the dot-probe task, variation in the 5-HTTLPR, and current social support among a community sample of adults (N = 216). Consistent with prior research, the S/LG homozygotes were more likely than the other genotype groups to have a negative attention bias. However, social support moderated the association between 5-HTTLPR variation and attentional bias. The S/LG homozygote group was particularly likely to exhibit greater attentional bias toward negative stimuli at low levels of social support. However, as social support improved, negative attention bias decreased. Findings suggest that supportive environments may attenuate genetic associations with negative attention bias.

Symptom assessment in early psychosis: The use of well-established rating scales in clinical high-risk and recent-onset populations

Symptom assessment in early psychosis research typically relies on scales validated in chronic schizophrenia samples. Our goal was to inform investigators who are selecting symptom scales for early psychosis research. We described measure characteristics, baseline scores, and scale inter-relationships in clinical-high-risk (CHR) and recent-onset psychotic disorder (RO) samples using the Positive and Negative Syndrome Scale, Brief Psychiatric Rating Scale, Scale for the Assessment of Positive Symptoms, and Scale for the Assessment of Negative Symptoms; for the CHR group only, we included the Scale of Prodromal Symptoms. For investigators selecting symptom measures in intervention or longitudinal studies, we also examined the relationship of symptom scales with psychosocial functioning. In both samples, symptom subscales in the same domain, across measures, were moderately to highly intercorrelated. Within all measures, positive symptoms were not correlated with negative symptoms, but disorganized symptoms overlapped with both positive and negative symptoms. Functioning was significantly related to negative and disorganized, but not positive, symptoms in both samples on most measures. Findings suggest strong overlap in symptom severity ratings among the most common scales. In recent-onset samples, each has strengths and weaknesses. In CHR samples, they appear to add little information above and beyond the SOPS.

The assessment of attenuated psychotic symptoms in adolescents: concepts, practical approaches and prediction of risk

The assessment of attenuated psychotic symptoms in adolescents: concepts, practical approaches and prediction of risk Rahel Pearson, Barbara Stuart, Rachel Loewy Abstract: Early detection of those at risk for developing psychotic disorders is a growing field that creates an opportunity for intervention early in the course of illness, with potential for improved prognosis. In the last two decades a number of instruments aimed at assessing clinical risk for psychosis were developed, using various approaches. These instruments are reviewed in this paper, as well as diagnostic and clinical challenges that mental health professionals often face during the assessment of attenuated psychotic symptoms, a core syndrome indicating psychosis risk. A case example illustrates assessment and feedback techniques. Keywords: assessment, diagnosis, high risk, prodromal, psychosis University of California at San Francisco 401 Parnassus Ave, Box 0984 San Francisco, CA. 94143

Additive genetic contribution to symptom dimensions in major depressive disorder.

Major depressive disorder (MDD) is a phenotypically heterogeneous disorder with a complex genetic architecture. In this study, genomic-relatedness-matrix restricted maximum-likelihood analysis (GREML) was used to investigate the extent to which variance in depression symptoms/symptom dimensions can be explained by variation in common single nucleotide polymorphisms (SNPs) in a sample of individuals with MDD (N = 1,558) who participated in the National Institute of Mental Health Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study. A principal components analysis of items from the Hamilton Rating Scale for Depression (HRSD) obtained prior to treatment revealed 4 depression symptom components: (a) appetite, (b) core depression symptoms (e.g., depressed mood, anhedonia), (c) insomnia, and (d) anxiety. These symptom dimensions were associated with SNP-based heritability (hSNP2) estimates of 30%, 14%, 30%, and 5%, respectively. Results indicated that the genetic contribution of common SNPs to depression symptom dimensions were not uniform. Appetite and insomnia symptoms in MDD had a relatively strong genetic contribution whereas the genetic contribution was relatively small for core depression and anxiety symptoms. While in need of replication, these results suggest that future gene discovery efforts may strongly benefit from parsing depression into its constituent parts. (PsycINFO Database Record

Acetaminophen enhances the reflective learning process

Abstract Acetaminophen has been shown to influence cognitive and affective behavior possibly via alterations in serotonin function. This study builds upon this previous work by examining the relationship between acetaminophen and dual‐learning systems, comprising reflective (rule‐based) and reflexive (information‐integration) processing. In a double‐blind, placebo‐controlled study, a sample of community‐recruited adults (N = 87) were randomly administered acetaminophen (1000 mg) or placebo and then completed reflective‐optimal and reflexive‐optimal category learning tasks. For the reflective‐optimal category learning task, acetaminophen compared to placebo was associated with enhanced accuracy prior to the first rule switch (but not overall accuracy), with needing fewer trials to reach criterion and with a faster learning rate. Acetaminophen modestly attenuated performance on the reflexive‐optimal category learning task compared to placebo. These findings indirectly support two positions that have been proposed elsewhere. First, they are consistent with the view that acetaminophen has an influence on the serotonergic system. Second, the findings are consistent with a proposed link between elevated serotonin function and relative dominance of effortful, rule‐based processing.

Childhood trauma and clinical high risk for psychosis

As a risk factor for psychosis, childhood trauma rates are elevated in the clinical-high-risk (CHR) syndrome compared to the general population. However, it is unknown whether trauma is typically experienced in childhood or adolescence/young adulthood, whether it occurred prior to CHR syndrome onset, and how severe trauma relates to presenting symptoms. In this study, we examined the relationship of trauma history to symptoms and functioning in individuals diagnosed with the CHR syndrome on the Structured Interview for Psychosis-Risk Syndromes (N = 103). Trauma, defined as meeting the DSM-IV A1 criterion of actual or threatened death or injury, was assessed by semi-structured interview. A large proportion of CHR participants (61%) reported trauma exposure, including interpersonal trauma, trauma prior to CHR onset, and childhood trauma prior to age 12. Those with a trauma history (versus those without trauma) were rated as having more severe perceptual disturbances, general/affective symptoms and more impairment on the Global Assessment of Functioning Scale. The number of traumatic events correlated with more severe ratings in those three domains. Additionally, the number of interpersonal traumas was correlated with ratings of suspiciousness. Trauma was unrelated to specific measures of social and role functioning. A small proportion of CHR participants were diagnosed with formal PTSD (14%), which was unrelated to symptom severity or functioning. Thus, we demonstrate that trauma exposure is often early in life (before age 12), occurs prior to the onset of the CHR syndrome, and is related to both positive and affective symptoms.