Depression, negative symptoms, social stagnation and social decline in the early course of schizophrenia

Häfner, Heinz; Löffler, W.; Maurer, Kurt; Hambrecht, Martin; Heiden, Wolfram an der

doi:10.1111/j.1600-0447.1999.tb10831.x

Cited by 371 publications

(277 citation statements)

References 56 publications

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“…The exception here is the RAP programme in New York, in which a clinical high-risk negative state is identified based on these symptoms (Cornblatt et al 2003;Lencz et al 2004). The lack of research interest in negative symptoms is surprising since these symptoms are described as part of the prodrome Häfner et al 1999) and social isolation/withdrawal has been shown to be a more common presenting symptom in at-risk samples than attenuated positive symptoms (Lencz et al 2004;Iyer et al 2008). Moreover, higher levels of negative symptoms at baseline, such as anhedonia, asociality and withdrawal, have been shown to predict transition to psychotic disorder Mason et al 2004;Riecher-Rössler et al 2007;Velthorst et al 2009;Piskulic et al 2012).…”

Section: Negative Symptomsmentioning

confidence: 99%

‘At-risk’ for psychosis research: where are we heading?

Lin

Nelson

Yung

2012

Epidemiol Psychiatr Sci

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The 'at-risk' criteria are a useful paradigm for investigating the psychological, neurocognitive, neurobiological and genetic risk factors for psychosis, specifically schizophrenia. To date, the primary outcome of interest in at-risk research has been the development of psychotic disorder, whereby patients are categorized as either having 'transitioned' or 'not transitioned'. Despite the acceptance of this dichotomy, it is important to consider that the threshold at which psychotic symptoms progress from attenuated to frank 'psychotic disorder' is arbitrary and may be incorrect or meaningless in terms of neurobiological and functional changes associated with psychosis. This has implications for clinical care and the search for markers of schizophrenia. We present recent research suggesting that the term 'outcome' needs to be broadened to incorporate non-psychotic diagnoses, functioning and negative symptoms. Shifting the traditional notion of outcome is the future challenge for at-risk research, but the inclusion of outcomes other than psychosis is likely to result in better aetiological models of psychotic illness.

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Section: Negative Symptomsmentioning

confidence: 99%

‘At-risk’ for psychosis research: where are we heading?

Lin

Nelson

Yung

2012

Epidemiol Psychiatr Sci

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“…Examples of the vulnerability factors on the behavioral level are cognitive deficits, social isolation, and school/work problems. On their own, these abnormalities, which typically precede positive symptoms by several years, 24 have been shown to lead to various levels of functional disability. 25 However, according to this model, when combined with the additional predisposition (likely having an independent genetic etiology) to develop positive symptoms, then psychoses evolve.…”

Section: Introductionmentioning

confidence: 99%

“…The RAP model was partially developed to accommodate the findings from earlier retrospective studies 24,[43][44][45] that negative symptoms were experienced by first episode patients several years before the emergence of positive symptoms. 24,[44][45][46] The first stage of the model (CHR−) was designed to prospectively study individuals who displayed the negative symptoms characterizing risk for psychosis (without accompanying positive symptoms), with the expectation that some proportion of these individuals would develop psychosis.…”

mentioning

confidence: 99%

A Severity-Based Clinical Staging Model for the Psychosis Prodrome: Longitudinal Findings From the New York Recognition and Prevention Program

Carrión

Correll

Auther

et al. 2017

SCHBUL

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Clinical staging improved the possibility of intervening during the psychosis prodrome to limit progression of illness. The current study aimed to validate a novel 4-stage severitybased model with a focus on clinical change over time and risk for conversion to psychosis. One hundred seventy-one individuals at clinical high risk (CHR) for psychosis were followed prospectively (3 ± 1.6 y) as part of the Recognition and Prevention (RAP) program and divided into 4 diagnostic stages according to absence/presence and severity of attenuated positive symptoms. Twenty-two percent of the combined sample recovered (no prodromal symptoms) by study outcome. The negative symptoms only subgroup had the highest symptom stability (70%), but the lowest conversion rate at 5.9%. The subgroup with more severe baseline attenuated positive symptom levels had a higher conversion rate (28%) and a more rapid onset when compared to the moderate attenuated positive symptom subgroup (11%). Finally, the Schizophrenia-Like Psychosis (SLP) subgroup showed low stability (3%), with 49% developing a specific psychotic disorder. The proposed stage model provides a more finely grained classification system than the standard diagnostic approach for prodromal individuals. All 4 stages are in need of early intervention because of low recovery rates. The negative symptom only stage is possibly a separate clinical syndrome, with an increased risk of functional disability. Both subgroups with attenuated positive symptoms are appropriate for studying the mechanisms of psychosis risk, however, individuals with more severe baseline positive symptoms appear better suited to clinical trials. Finally, the SLP category represents an intermediate outcome group appropriate for preventative intervention research but questionable for inclusion in prodromal studies of mechanisms.

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“…This overview of similar and almost interchangeable concepts mirrors the often enigmatic task to disentangle psychotic from non-psychotic processes; a task that is all the more challenged by the finding that impaired level of both social and vocational functioning is one of the earliest phenomena in evolving psychosis [44].…”

Section: Level Of Functioningmentioning

confidence: 99%

“…However, even if cenesthetic schizophrenia are described to develop progressively along an extended prodromal period, Huber noted that in one quarter of all cases, psychosis onset was acute and occurred as dysesthetic crises [15,33]. Further, up to 70% of patients that develop schizophrenia report to have experienced episodic or sustained symptoms of anxiety during the prodromal phases [44].…”

Section: Mode Of Onsetmentioning

confidence: 99%

Cenesthopathy in adolescence: An appraisal of diagnostic overlaps along the anxiety–hypochondriasis–psychosis spectrum

Simon

Borgwardt

Lang

et al. 2014

Comprehensive Psychiatry

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Objective: To discuss the diagnostic validity of unusual bodily perceptions along the spectrum from age-specific, often transitory and normal, to pathological phenomena in adolescence to hypochondriasis and finally to psychosis. Methods: Critical literature review of the cornerstone diagnostic groups along the spectrum embracing anxiety and cenesthopathy in adolescence, hypochondriasis, and cenesthopathy and psychosis, followed by a discussion of the diagnostic overlaps along this spectrum. Results: The review highlights significant overlaps between the diagnostic cornerstones. It is apparent that adolescents with unusual bodily perceptions may conceptually qualify for more than one diagnostic group along the spectrum. To determine whether cenesthopathies in adolescence mirror emerging psychosis, a number of issues need to be considered, i.e. age and mode of onset, gender, level of functioning and drug use. The role of overvalued ideas at the border between hypochondriasis and psychosis must be considered. Conclusion: As unusual bodily symptoms may in some instances meet formal psychosis risk criteria, a narrow understanding of these symptoms may lead to both inappropriate application of the new DSM-5 attenuated psychosis syndrome and of treatment selection. On the other hand, the possibility of a psychotic dimension of unusual bodily symptoms in adolescents must always be considered as most severe expression of the cenesthopathy spectrum. We would like to thank the reviewer for raising this important point. As we did not follow specific guidelines "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" (PRISMA) guidelines (Moher et al., 2009), we agree with your comment that this a selective and not systematic review. Therefore, we now removed the term "systematic" and clearly state that this is a "critical" review. Furthermore, we have rephrased the methods in more detail on page 4, line 21, to page 5, line 9. We also acknowledge that including a discussion of somatization is an important aspect. This now features on page 9, lines 3 to 19. We did not include a discussion of the Briquet"s syndrome. This is a specific somatization disorder with multiple symptoms, and our above mentioned paragraph includes the general concept of somatization, thus also Briquet"s syndrome. We however now included the concept of somatic delusions in our section on "cenesthopathy and psychosis" that we have restructured substantially (see page 12, lines 13 to 24). We now also reference somatic delusions on page 16, line 7 (references 52 and 53). The main conclusion of the paper is that there is the risk that the DSM-5 attenuated psychosis syndrome may be over-diagnosed given the fact that unusual body experiences seem to be an aspecific feature of several disorders not only psychosis. I did not find a solid argument for this conclusion in the discussion. Also could the authors offer any suggestions to avoid this problem of overdiagnosis and propose alternate methods of assessment and appraisal of distortions ...

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Depression, negative symptoms, social stagnation and social decline in the early course of schizophrenia

Cited by 371 publications

References 56 publications

‘At-risk’ for psychosis research: where are we heading?

‘At-risk’ for psychosis research: where are we heading?

A Severity-Based Clinical Staging Model for the Psychosis Prodrome: Longitudinal Findings From the New York Recognition and Prevention Program

Cenesthopathy in adolescence: An appraisal of diagnostic overlaps along the anxiety–hypochondriasis–psychosis spectrum

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