Psychosis as a continuous phenotype in the general population: the thin line between normality and pathology

David, Anthony S.; Ajnakina, Olesya

doi:10.1002/wps.20327

Cited by 13 publications

(9 citation statements)

References 11 publications

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“…These figures vary depending on different methods of data acquisition and categorisation (David, 2010). Thus, it is difficult to define with certainty when an individual transits from pre-psychotic symptoms to the ARMS, and at the other end from the ARMS to clinical psychosis (David and Ajnakina, 2016).…”

Section: Criticisms Of the Arms Conceptmentioning

confidence: 99%

‘At risk mental state’ clinics for psychosis – an idea whose time has come – and gone!

2018

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At Risk Mental State (ARMS) clinics are specialised mental health services for young, help-seeking people, thought to be at ultra-high risk of developing psychosis. Their stated purpose is to reduce transitions from the ARMS state to clinical psychotic disorder. Reports of ARMS clinics provide ‘evidence-based recommendations’ or ‘guidance’ for the treatment of such individuals, and claim that such clinics prevent the development of psychosis. However, we note that in an area with a very well-developed ARMS clinic (South London), only a very small proportion (4%) of patients with first episode psychosis had previously been seen at this clinic with symptoms of the ARMS. We conclude that the task of reaching sufficient people to make a major contribution to the prevention of psychosis is beyond the power of ARMS clinics. Following the preventative approaches used for many medical disorders (e.g. lung cancer, coronary artery disease), we consider that a more effective way of preventing psychosis will be to adopt a public health approach; this should attempt to decrease exposure to environmental factors such as cannabis use which are known to increase risk of the disorder.

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Section: Criticisms Of the Arms Conceptmentioning

confidence: 99%

‘At risk mental state’ clinics for psychosis – an idea whose time has come – and gone!

2018

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“…Psychosis is a broad and rather non-specific term (David & Ajnakina, 2016). It has been in use since the 1900s, when physicians began attributing mental disorders (or 'insanities') to underlying disorders of the brain.…”

Section: Psychotic Disorder V Psychotic Symptommentioning

confidence: 99%

Auditory hallucinations, not necessarily a hallmark of psychotic disorder

et al. 2017

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Auditory hallucinations (AH) are often considered a sign of a psychotic disorder. This is promoted by the DSM-5 category of Other Specified Schizophrenia Spectrum And Other Psychotic Disorder (OSSSOPD), the diagnostic criteria for which are fulfilled with the sole presence of persistent AH, in the absence of any other psychotic symptoms. And yet, persistent AH are not synonymous with having a psychotic disorder, and should therefore not be uncritically treated as such. Many people who seek treatment for persistent AH have no other psychotic symptoms, have preserved realitytesting capacities, and will never develop a schizophrenia spectrum disorder. Instead, hallucinations may be the result of many different causes, including borderline personality disorder, post-traumatic stress disorder (PTSD), hearing loss, sleep disorders or brain lesions, and they may even occur outside the context of any demonstrable pathology. In such cases, the usage of the DSM-5 diagnosis of OSSSOPD would be incorrect, and it may prompt unwarranted treatment with antipsychotic medication. We therefore argue that a DSM-5 diagnosis of Schizophrenia Spectrum Disorder (or any other type of psychotic disorder) characterized by AH should require at least one more symptom listed under the A-criterion (i.e. delusions, disorganized speech, disorganized or catatonic behavior or negative symptoms). Adhering to these more stringent criteria may help to distinguish between individuals with persistent AH which are part of a psychotic disorder, for whom antipsychotic medication may be helpful, and individuals with AH in the absence of such a disorder who may benefit from other approaches (e.g. different pharmacological interventions, improving coping style, trauma-related therapy).

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“…Subclinical psychotic symptoms also share etiological risk factors, cognitive correlates, and symptom profiles with SZ [3], and can be a harbinger of subsequent full-blown illness. Similar to transition rates for clinical high-risk youth [10], up to 25% of individuals who report these experiences convert to a diagnosed psychotic disorder by adulthood [11,12]. For those who do not convert, approximately 30-40% continue to experience these subclinical symptoms into early adulthood [13,14] and, potentially, throughout life [15].…”

Section: Introductionmentioning

confidence: 82%

Disruptions in White Matter Maturation and Mediation of Cognitive Development in Youth on the Psychosis Spectrum

Hegarty

Jolles

Mennigen³

et al. 2018

Preprint

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Background: Psychosis onset typically occurs in adolescence, and subclinical psychotic experiences peak in adolescence as well. Adolescence is also a time of critical neural and cognitive maturation. Using cross-sectional data from the Philadelphia Neurodevelopmental Cohort, we examine whether regional white matter (WM) development is disrupted in psychosis spectrum (PS) youth whether WM maturation mediates the relationship between age and cognition in typically developing (TD) and PS youth. A third group with intermediate symptom severity (limited PS [LPS]) was included in follow-up analyses to determine whether age-related disruptions in WM scaled with symptom severity.Methods: We examined WM microstructure, as assessed via diffusion tensor imaging, in 707 individuals (aged 10-22 years; 499 TD, 171 PS, 37 LPS) by using Tract-Based Spatial Statistics. Multiple regressions were used to evaluate age x group interactions on regional WM indices. Mediation analyses were conducted using a bootstrapping approach.Results: There were age x group interactions on fractional anisotropy (FA) in the superior longitudinal fasciculus (SLF) and retrolenticular internal capsule (RLIC). SLF FA mediated the relationship between age and Complex Cognition in TD, but not PS. Further, inclusion of LPS youth showed that the relationship between age and SLF FA decreased with increasing symptom severity Conclusions: Our results show aberrant age-related changes in SLF and RLIC FA in PS youth. SLF development supports emergence of specific higher-order cognitive functions in TD youth, but not in PS. Future mechanistic explanations for these relationships could facilitate development of earlier and refined targets for therapeutic interventions.

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Psychosis as a continuous phenotype in the general population: the thin line between normality and pathology

Cited by 13 publications

References 11 publications

‘At risk mental state’ clinics for psychosis – an idea whose time has come – and gone!

‘At risk mental state’ clinics for psychosis – an idea whose time has come – and gone!

Auditory hallucinations, not necessarily a hallmark of psychotic disorder

Disruptions in White Matter Maturation and Mediation of Cognitive Development in Youth on the Psychosis Spectrum

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