Frequency and Correlates of &lt;em&gt;DSM-5&lt;/em&gt; Attenuated Psychosis Syndrome in a Sample of Adolescent Inpatients With Nonpsychotic Psychiatric Disorders

Gerstenberg, Miriam; Hauser, Marta; Al-Jadiri, Aseel; Sheridan, E. Marcia; Kishimoto, Toshifumi; Borenstein, Yehonatan; Vernal, Ditte Lammers; David, Lisa R.; Saito, Ema; Landers, Sara E.; Carella, Morgan; Singh, Sukhbir; Carbon, Maren; Jiménez‐Fernández, Sara; Birnbaum, Michael L.; Auther, Andrea M.; Carrión, Ricardo; Cornblatt, Barbara A.; Kane, John M.; Walitza, Susanne; Correll, Christoph U.

doi:10.4088/jcp.14m09435

Cited by 22 publications

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“…Contrary to brain morphological abnormalities observed in adults at CHR-P (Harrisberger et al, 2016;Walter et al, 2016), structural alterations have not been robustly confirmed in adolescents at CHR-P (Ziermans et al, 2009). These differences may reflect different maturational ages of the brain across these two populations or may alternatively be due to a lower true-positive rate for psychosis in paediatric CHR-P samples due to more nonspecific and overlapping phenomenologies of concurrently emerging psychiatric disorders (Gerstenberg et al, 2015(Gerstenberg et al, , 2016Kelleher et al, 2012;Schimmelmann, Michel, Martz-Irngartinger, Linder, & Schultze-Lutter, 2015).…”

Section: Discussionmentioning

confidence: 99%

“…Clinical comorbidity in the CHR-P state. Systematic review: Six studies had a primary focus on the investigation of comorbidities in CHR-P (Gerstenberg et al, 2015;Kline et al, 2016;Morelli et al, 2019; Pelizza, Poletti, et al, 2019;Pitzianti et al, 2019;Stain et al, 2018). Comorbidity was frequent (from 46.4% to 7%) in adolescents at CHR-P (Table S7).…”

Section: Meta-analysismentioning

confidence: 99%

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Annual Research Review: Prevention of psychosis in adolescents – systematic review and meta‐analysis of advances in detection, prognosis and intervention

Catalán

Pablo

Serrano

et al. 2020

Child Psychology Psychiatry

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Background: The clinical high-risk state for psychosis (CHR-P) paradigm has facilitated the implementation of psychosis prevention into clinical practice; however, advancements in adolescent CHR-P populations are less established. Methods: We performed a PRISMA/MOOSE-compliant systematic review of the Web of Science database, from inception until 7 October 2019, to identify original studies conducted in CHR-P children and adolescents (mean age <18 years). Findings were systematically appraised around core themes: detection, prognosis and intervention. We performed meta-analyses (employing Q statistics and I 2 test) regarding the proportion of CHR-P subgroups, the prevalence of baseline comorbid mental disorders, the risk of psychosis onset and the type of interventions received at baseline. Quality assessment and publication bias were also analysed. Results: Eighty-seven articles were included (n = 4,667 CHR-P individuals). Quality of studies ranged from 3.5 to 8 (median 5.5) on a modified Newcastle-Ottawa scale. Detection: Individuals were aged 15.6 AE 1.2 years (51.5% males), mostly (83%) presenting with attenuated positive psychotic symptoms. CHR-P psychometric accuracy improved when caregivers served as additional informants. Comorbid mood (46.4%) and anxiety (31.4%) disorders were highly prevalent. Functioning and cognition were impaired. Neurobiological studies were inconclusive. Prognosis: Risk for psychosis was 10.4% (95%CI: 5.8%-18.1%) at 6 months, 20% (95% CI: 15%-26%) at 12 months, 23% (95%CI: 18%-29%) at 24 months and 23.3% (95%CI: 17.3%-30.7%) at ≥36 months. Interventions: There was not enough evidence to recommend one specific treatment (including cognitive behavioural therapy) over the others (including control conditions) to prevent the transition to psychosis in this population. Randomised controlled trials suggested that family interventions, cognitive remediation and fish oil supplementation may improve cognition, symptoms and functioning. At baseline, 30% of CHR-P adolescents were prescribed antipsychotics and 60% received psychotherapy. Conclusions: It is possible to detect and formulate a group-level prognosis in adolescents at risk for psychosis. Future interventional research is required.

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Section: Discussionmentioning

confidence: 99%

Section: Meta-analysismentioning

confidence: 99%

Annual Research Review: Prevention of psychosis in adolescents – systematic review and meta‐analysis of advances in detection, prognosis and intervention

Catalán

Pablo

Serrano

et al. 2020

Child Psychology Psychiatry

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129

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“…While most reports to date on APS are based on cohorts that also include adults (25,(28)(29)(30), APS features often occur for the first time in adolescence (31,32). Broadly speaking, studies that focus on DSM-5-APS in adolescents are scarce (21,22), and there are few studies on APS in adolescents in clinical care and hospital settings.…”

Section: Introductionmentioning

confidence: 99%

“…To our knowledge, only a few efforts have been made (22,33,34) to characterize APS, excluding other ultra-high risk criteria, and advance knowledge specifically in children and adolescents, comparing them to other help-seeking individuals. Among them, 22 APS individuals were compared to other treatment-seeking individuals and healthy controls regarding clinical and cognitive features (34), finding that APS was associated with impaired neurocognition.…”

Section: Introductionmentioning

confidence: 99%

DSM-5 Attenuated Psychosis Syndrome in Adolescents Hospitalized With Non-psychotic Psychiatric Disorders

et al. 2020

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Introduction: Although attenuated psychotic symptoms often occur for the first time during adolescence, studies focusing on adolescents are scarce. Attenuated psychotic symptoms form the criteria to identify individuals at increased clinical risk of developing psychosis. The study of individuals with these symptoms has led to the release of the DSM-5 diagnosis of Attenuated Psychosis Syndrome (APS) as a condition for further research. We aimed to characterize and compare hospitalized adolescents with DSM-5-APS diagnosis vs. hospitalized adolescents without a DSM-5-APS diagnosis. Methods: Interviewing help-seeking, hospitalized adolescents (aged 12-18 years) and their caregivers independently with established research instruments, we (1) evaluated the presence of APS among non-psychotic adolescents, (2) characterized and compared APS and non-APS individuals regarding sociodemographic, illness and intervention characteristics, (3) correlated psychopathology with levels of functioning and severity of illness and (4) investigated the influence of individual clinical, functional and comorbidity variables on the likelihood of participants to be diagnosed with APS. Results: Among 248 consecutively recruited adolescents (age=15.4 ± 1.5 years, females = 69.6%) with non-psychotic psychiatric disorders, 65 (26.2%) fulfilled APS criteria and 183 (73.8%) did not fulfill them. Adolescents with APS had higher number Salazar de Pablo et al. DSM-5 Attenuated Psychosis Syndrome in Adolescents of psychiatric disorders than non-APS adolescents (3.5 vs. 2.4, p < 0.001; Cohen's d = 0.77), particularly, disruptive behavior disorders (Cramer's V = 0.16), personality disorder traits (Cramer's V = 0.26), anxiety disorders (Cramer's V = 0.15), and eating disorders (Cramer's V = 0.16). Adolescents with APS scored higher on positive (Cohen's d = 1.5), negative (Cohen's d = 0.55), disorganized (Cohen's d = 0.51), and general symptoms (Cohen's d = 0.84), and were more severely ill (Cohen's d = 1.0) and functionally impaired (Cohen's d = 0.31). Negative symptoms were associated with lower functional levels (Pearson ρ = −0.17 to −0.20; p = 0.014 to 0.031). Global illness severity was associated with higher positive, negative, and general symptoms (Pearson ρ = 0.22 to 0.46; p = 0.04 to p < 0.001). APS status was independently associated with perceptual abnormalities (OR = 2.0; 95% CI = 1.6-2.5, p < 0.001), number of psychiatric diagnoses (OR = 1.5; 95% CI = 1.2-2.0, p = 0.002), and impaired stress tolerance (OR = 1.4; 95% CI = 1.1-1.7, p = 0.002) (r 2 = 0.315, p < 0.001). Conclusions: A considerable number of adolescents hospitalized with non-psychotic psychiatric disorders meet DSM-5-APS criteria. These help-seeking adolescents have more comorbid disorders and more severe symptoms, functional impairment, and severity of illness than non-APS adolescents. Thus, they warrant high intensity clinical care.

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“…This area of conflict is influenced by many different and important factors, among others, by clinicians' uncertainties about the validity of the CHR state in people with highly complex symptom combinations, mostly multiple comorbid psychiatric disorders, additional biological and environmental risk factors, and often frequent childhood adversities. In fact, several recent studies suggest that at least the psychosis CHR criteria may affect a higher proportion of adolescents than adults, with emergence of CHR criteria-based symptomatology at the same time as other mental disorders emerge, complicating the clinical picture [140][141][142]. Furthermore, in a program focusing predominantly on adolescents, younger age of onset of CHR criteria within adolescence was associated with lower conversion rates to psychosis [21].…”

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confidence: 99%

Pharmacotherapy in Children and Adolescents at Clinical-High Risk for Psychosis and Bipolar Disorder

2016

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This review aims to describe the importance of i) detecting individuals at clinical high-risk for psychosis (schizophrenia) or bipolar disorder, especially in children and adolescents, in order to enable early intervention, and ii) evaluating different intervention strategies, especially pharmacotherapy, during the subsyndromal or "prodromal" stages of these severe and often debilitating disorders. The different approaches regarding the psychotic and bipolar clinical high-risk state are discussed, including reasons and evidence for early (pharmacological) intervention and risks of treatment vs. non-treatment. Only 10 prospective studies of antipsychotics (randomized=4) and 6 prospective studies of non-antipsychotic pharmacologic agents (randomized=3, i. e., omega-3 fatty acids=2, glycine=1) for the psychotic clinical high-risk state and only 4 prospective studies of mood stabilizing medications for the bipolar clinical high-risk state (randomized=2, i. e., lithium=1, valproate=1) were detected. Based on the minimal efficacy data, adverse effect risks, especially in pediatric populations, nonspecific psychopathology, and unknown true risk for the development of either psychosis or bipolar disorder or of chronically disabling symptoms and disability, medication treatment currently remains second choice after psychosocial intervention. Additional research in this area is clearly needed in order to shed more light on the relevance and predictive value of potentially prodromal symptoms, their identification and most appropriate management options.

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Frequency and Correlates of <em>DSM-5</em> Attenuated Psychosis Syndrome in a Sample of Adolescent Inpatients With Nonpsychotic Psychiatric Disorders

Abstract: ClinicalTrials.gov identifier: NCT01383915.

Cited by 22 publications

References 0 publications

Annual Research Review: Prevention of psychosis in adolescents – systematic review and meta‐analysis of advances in detection, prognosis and intervention

Annual Research Review: Prevention of psychosis in adolescents – systematic review and meta‐analysis of advances in detection, prognosis and intervention

DSM-5 Attenuated Psychosis Syndrome in Adolescents Hospitalized With Non-psychotic Psychiatric Disorders

Pharmacotherapy in Children and Adolescents at Clinical-High Risk for Psychosis and Bipolar Disorder

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