Basic Symptoms and Ultrahigh Risk Criteria: Symptom Development in the Initial Prodromal State

Abstract

Symptom development during the prodromal phase of psychosis was explored retrospectively in first-episode psychosis patients with special emphasis on the assumed time-related syndromic sequence of "unspecific symptoms (UN)-predictive basic symptoms (BS)-attenuated psychotic symptoms (APS)-(transient) psychotic symptoms (PS)." Onset of syndromes was defined by first occurrence of any of their respective symptoms. Group means were inspected for time differences between syndromes and influence of sociodemographic and clinical characteristics on the recalled sequence. The sequence of "UN-BS/APS-PS" was clearly supported, and both BS and, though slightly less, APS were highly sensitive. However, onset of BS and APS did not show significant time difference in the whole sample (N = 126; 90% schizophrenia), although when each symptom is considered independently, APS tended to occur later than first predictive BS. On descriptive level, about one-third each recalled an earlier, equal and later onset of BS compared with APS. Level of education showed the greatest impact on the recall of the hypothesized sequence. Thereby, those with a higher school-leaving certificate supported the assumed sequence, whereas those of low educational background retrospectively dated APS before BS. These findings rather point out recognition and recall bias inherent to the retrospective design than true group characteristics. Future long-term prospective studies will have to explore this conclusively. However, as regards the criteria, the results support the notion of BS as at least a complementary approach to the ultrahigh risk criteria, which may also allow for an earlier detection of psychosis.

Reduced activation in the ventral striatum during probabilistic decision-making in patients in an at-risk mental state

“…23 However, including cognitive basic symptoms 26 in the characterization of patients seems to be a necessary and complementary approach to ultra-high risk (UHR) criteria, allowing for the detection of earlier stages of ARMS. 27,28 Yet, the importance of metacognition in early prodromal stages and the interaction with cognitive basic symptoms is still unclear.…”

Morphological brain changes associated with negative symptoms in patients with 22q11.2 Deletion Syndrome

“…We therefore argue that the study of negative symptoms is critical as they have a higher prevalence than positive symptoms in the prodromal psychotic phase (Cornblatt et al, 2003;McGlashan et al, 2001;Phillips et al, 2005;Schultze-Lutter et al, 2010). Negative symptoms are often accompanied by cognitive deficits (Addington et al, 1991;Basso et al, 1998), worse psychosis outcome (Milev et al, 2005), social impairments (Lincoln et al, 2011;Milev et al, 2005), and poorer occupational and daily functioning (Milev et al, 2005;Rabinowitz et al, 2012).…”

Estados clínicos de alto riesgo para esquizofrenia y otras formas de psicosis: una breve revisión.

“…La concepción actual de los SB implica una secuencia en el proceso de la enfermedad (gráfico 3), que va desde síntomas inespecíficos a síntomas básicos predictivos, síntomas positivos atenuados, síntomas psicóticos transitorios y finalmente síntomas psicóticos característicos (78). Esta secuencia es muy variable, y hay pacientes que van a presentar remisiones y recaídas.…”