Riccardo Saba

Adolescents at ultra-high risk for psychosis with and without 22q11 deletion syndrome: A comparison of prodromal psychotic symptoms and general functioning

OBJECTIVE Genetic syndromes related to psychosis have become increasingly important for exploring the trajectory that leads to psychosis onset. A very significant opportunity for mapping earlier phases of the trajectory can be found in 22q11.2 deletion syndrome (22q11DS). Comparative studies have shown that schizophrenic disorder in 22q11DS largely resembles schizophrenia in the general population, but only few studies have investigated the features of prodromal symptoms in 22q11DS. The aim of the present study was to investigate differences and similarities between two samples: patients with 22q11DS clinically at risk for psychotic onset (UHR+22q11DS group) and patients at clinical high risk for psychotic onset (UHR group). METHOD The study was conducted on a sample of 30 individuals UHR+22q11DS and 81 individuals at UHR without 22q11DS. The two groups were compared on positive, negative and depressive symptoms, level of general functioning and IQ. RESULTS There was a significant group difference in negative symptoms, but no significant differences were found for positive, global and total symptoms. The UHR+22q11DS group showed a lower level of general functioning. The clinical profile of the UHR+22q11DS group was clearly more homogeneous. CONCLUSIONS Even if the two UHR groups are comparable in terms of positive symptoms, the UHR+22q11DS have a specific clinical pattern characterized by higher negative symptoms, lower general functioning and an older age of onset of the UHR state. This finding may be of clinical value for the development of specific therapeutic intervention for UHR+22q11DS, and of theoretical value since the two groups may share only some underlying etiopathogenetic mechanisms.

Psychotic experience subtypes, poor mental health status and help-seeking behaviour in a community sample of young adults

Background: Different subtypes of psychotic experiences (PEs) have been identified in clinical and non‐clinical samples. Researchers have considered these PEs to either be variations of personality or expressions of vulnerability to psychotic disorder. This study aimed to determine which particular subtypes of PEs were more likely to be associated with poor mental health status and help‐seeking behaviour in a non‐clinical sample of young adults.

Interpersonal sensitivity and functioning impairment in youth at ultra-high risk for psychosis

A personality trait that often elicits poor and uneasy interpersonal relationships is interpersonal sensitivity. The aim of the present study was to explore the relationship between interpersonal sensitivity and psychosocial functioning in individuals at ultra-high risk for psychosis as compared to help-seeking individuals who screened negative for an ultra-high risk of psychosis. A total sample of 147 adolescents and young adult who were help seeking for emerging mental health problems participated in the study. The sample was divided into two groups: 39 individuals who met criteria for an ultra-high-risk mental state (UHR), and 108 (NS). The whole sample completed the Interpersonal Sensitivity Measure (IPSM) and the Global Functioning: Social and Role Scale (GF:SS; GF:RS). Mediation analysis was used to explore whether attenuated negative symptoms mediated the relationship between interpersonal sensitivity and social functioning. Individuals with UHR state showed higher IPSM scores and lower GF:SS and GF:RS scores than NS participants. A statistically negative significant correlation between two IPSM subscales (Interpersonal Awareness and Timidity) and GF:SS was found in both groups. Our results also suggest that the relationship between the aforementioned aspects of interpersonal sensitivity and social functioning was not mediated by negative prodromal symptoms. This study suggests that some aspects of interpersonal sensitivity were associated with low level of social functioning. Assessing and treating interpersonal sensitivity may be a promising therapeutic target to improve social functioning in young help-seeking individuals.

Prevalence of psychotic-like experiences in young adults with social anxiety disorder and correlation with affective dysregulation

Abstract Social anxiety disorder (SAD) is associated with psychotic-like experiences (PLEs) and is a frequent diagnosis in the prodromal phases of psychosis. We investigated whether psychopathological factors could discriminate which subjects with SAD are more likely to develop PLEs. A sample of 128 young adults with SAD was split into two subsamples according to the presence of clinically relevant PLEs. Correlations between PLEs and other psychopathological markers were explored. The SAD with PLEs group showed higher level of anxiety, depression, and intolerance of uncertainty (IU) compared with the SAD without PLEs group. A limitation of this study is that the cross-sectional design precluded the analysis of causality. In our sample, the presence of PLEs is related to higher levels of depression, anxiety, and IU. The current findings are consistent with hypotheses suggesting that cognitive disturbances, together with social anxiety, may result in PLEs.

Interpersonal sensitivity, bullying victimization and paranoid ideation among help-seeking adolescents and young adults

The effects of a negative interpersonal experience, such as bullying victimization in childhood and adolescence, can be strong and long lasting. Bullying victimization is associated with paranoid ideation and suspiciousness. Few studies have focused on personality traits of victims of bullying. The aim of this study is to investigate whether a particular personality trait called interpersonal sensitivity may be related to suspiciousness in those who experienced bullying victimization.

Impairment in Social Functioning differentiates youth meeting Ultra-High Risk for psychosis criteria from other mental health help-seekers: A validation of the Italian version of the Global Functioning: Social and Global Functioning: Role scales

Social and occupational impairments are present in the schizophrenia prodrome, and poor social functioning predicts transition to psychosis in Ultra-High Risk (UHR) individuals. We aimed to: 1) validate the Italian version of the Global Functioning: Social (GF: S) and Global Functioning: Role (GF: S) scales; 2) evaluate their association with UHR criteria. Participants were 12-21-years-old (age, mean=15.2, standard deviation=2.1, male/female ratio=117/120) nonpsychotic help-seekers, meeting (N=39) or not (N=198) UHR criteria. Inter-rater reliability was excellent for both scales, which also showed good to excellent concurrent validity, as measured by correlation with Global Assessment of Functioning (GAF) scores. Furthermore, GF:S and GF: R were able to discriminate between UHRs and non-UHRs, with UHRs having lower current scores. After adjusting for current GAF scores, only current GF:S scores independently differentiated UHR from non-UHR (OR=1.33, 95%CI: 1.02-1.75, p=0.033). Finally, UHR participants showed a steeper decrease from highest GF:S and GF: R scores in the past year to their respective current scores, but not from highest past year GAF scores to current scores. GF:S/GS: R scores were not affected by age or sex. GF:S/GF: R are useful functional level and outcome measures, having the advantage over the GAF to not confound functioning with symptom severity. Additionally, the GF:S may be helpful in identifying UHR individuals.

Youth mental health services in Italy: An achievable dream?

“Liberiamo il futuro” (LIF) project was designed to assess psychological problems of adolescents and young adults and to identify individuals at high‐risk for developing a psychosis through a collaboration between a University team, Child and Adolescent Mental Health Services and Adult Mental Health Services. This paper presents the baseline demographic and clinical characteristics of the cohort, particularly the nature and severity of psychopathology.

Diagnostic distribution of self-disorders in help-seeking adolescents: an early faeature of the schizophrenia spectrum

Aims: The first aim was to determine the cost-effectiveness of CBTuhr to prevent first-episode psychosis in ultra-high risk (UHR) at 18 and 48 months. The second aim was to develop an optimized prediction model of a first-episode psychosis. Methods: 196 help-seeking UHR patients participated in the Early Detection Intervention (EDIE) study in the Netherlands. All individuals were treated with routine care (RC) for non-psychotic disorders. The experimental group received add-on CBTuhr to prevent psychosis. Results: The CBTuhr intervention was cost saving at 18 and 48 months follow-up. This was achieved by less hospital admissions and a reduction in other service costs. Societal costs were reduced because more treated patients were employed. Prognostic modelling identified 3 UHR risk classes with 4%, 13% and 70% risk for transition within 18 months. In the highest risk class, transition to psychosis emerged on average ≥ 8 months earlier than in the lowest risk class. Conclusions: Using prognostic modelling and proactive care can accomplish health gain at lower costs.

Dream interpretation: a possible diagnostic method during the “prodromal” phase of psychosis

Aims: The first aim was to determine the cost-effectiveness of CBTuhr to prevent first-episode psychosis in ultra-high risk (UHR) at 18 and 48 months. The second aim was to develop an optimized prediction model of a first-episode psychosis. Methods: 196 help-seeking UHR patients participated in the Early Detection Intervention (EDIE) study in the Netherlands. All individuals were treated with routine care (RC) for non-psychotic disorders. The experimental group received add-on CBTuhr to prevent psychosis. Results: The CBTuhr intervention was cost saving at 18 and 48 months follow-up. This was achieved by less hospital admissions and a reduction in other service costs. Societal costs were reduced because more treated patients were employed. Prognostic modelling identified 3 UHR risk classes with 4%, 13% and 70% risk for transition within 18 months. In the highest risk class, transition to psychosis emerged on average ≥ 8 months earlier than in the lowest risk class. Conclusions: Using prognostic modelling and proactive care can accomplish health gain at lower costs.

Perceptive and not perceptive attenuated psychotic symptom and their association with functioning and psychopathology in a clinical sample of adolescents and young adults. An italian perspective.

Aims: The first aim was to determine the cost-effectiveness of CBTuhr to prevent first-episode psychosis in ultra-high risk (UHR) at 18 and 48 months. The second aim was to develop an optimized prediction model of a first-episode psychosis. Methods: 196 help-seeking UHR patients participated in the Early Detection Intervention (EDIE) study in the Netherlands. All individuals were treated with routine care (RC) for non-psychotic disorders. The experimental group received add-on CBTuhr to prevent psychosis. Results: The CBTuhr intervention was cost saving at 18 and 48 months follow-up. This was achieved by less hospital admissions and a reduction in other service costs. Societal costs were reduced because more treated patients were employed. Prognostic modelling identified 3 UHR risk classes with 4%, 13% and 70% risk for transition within 18 months. In the highest risk class, transition to psychosis emerged on average ≥ 8 months earlier than in the lowest risk class. Conclusions: Using prognostic modelling and proactive care can accomplish health gain at lower costs.