The Psychosis High-Risk State

Fusar‐Poli, Paolo; Borgwardt, Stefan; Bechdolf, Andreas; Addington, Jean; Riecher-Rössler, Anita; Schultze‐Lutter, Frauke; Keshavan, Matcheri S.; Wood, Stephen; Ruhrmann, Stephan; Seidman, Larry J.; Valmaggia, Lucia; Cannon, Tyrone D.; Velthorst, Eva; Haan, Lieuwe de; Cornblatt, Barbara A.; Bonoldi, Ilaria; Birchwood, Max; McGlashan, Thomas H.; Carpenter, William T.; McGorry, Patrick D.; Klosterkötter, Joachim; McGuire, Philip; Yung, Alison R.

doi:10.1001/jamapsychiatry.2013.269

Cited by 1,215 publications

(527 citation statements)

References 154 publications

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“…Accordingly, in the early stages of the disease, at the first-ep-isode [89] and during the proceeding years [98,99], the presence of this symptom cluster is one of the greatest barriers to the achievement of functional recovery. Moreover, before full blown psychosis occurs, during the so-called high-risk (HR) or prodromal state, negative symptoms and impaired social cognition have been associated with marked impairment in psychosocial function [100,101] which appears to be a core feature of the HR state and tends to be resistant to all types of treatment [102]. The presence of negative symptoms of "avolition" and "poor emotional expression" in the prodrome is in agreement with the notion of their primary nature and suggests that negative symptoms and their neural substrates may even be a driver (like impaired social cognition) of transition to psychosis [85].…”

Section: Negative Symptoms and Psychosocial Functioningmentioning

confidence: 99%

“…Current research into the determinants of social functioning impairments in HR individuals suggests that motivational impairment is more important in determining level of social functioning relative to expression symptoms of affective flattening and alogia [101]. Correspondingly, it may be hypothesized that treatments alleviating negative symptoms in HR young subjects would both alleviate suffering and reduce the risk of transition to schizophrenia [85,102].…”

Section: Negative Symptoms and Psychosocial Functioningmentioning

confidence: 99%

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Social Cognition, Negative Symptoms and Psychosocial Functioning in Schizophrenia

Madeira¹,

Caldeira²,

Bajouco³

et al. 2016

IJCNMH

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Although functional recovery could be advocated as an achievable treatment goal, many effective interventions for the treatment of psychotic symptoms, such as antipsychotic drugs, may not improve functioning. The last two decades of cognitive and clinical research on schizophrenia were a turning point for the firm acknowledgment of how relevant social cognitive deficits and negative symptoms could be in predicting psychosocial functioning. The relevance of social cognition dysfunction in schizophrenia patients' daily living is now unabated. In fact, social cognition deficits could be the most significant predictor of functionality in patients with schizophrenia, non-redundantly with neurocognition. Emerging evidence suggests that negative symptoms appear to play an indirect role, mediating the relationship between neurocognition and social cognition with functional outcomes. Further explorations of this mediating role of negative symptoms have revealed that motivational deficits appear to be particularly important in explaining the relationship between both neurocognitive and social cognitive dysfunction and functional outcomes in schizophrenia. In this paper we will address the relative contribution of two key constructs-social cognitive deficits and negative symptoms, namely how intertwined they could be in daily life functioning of patients with schizophrenia.

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Section: Negative Symptoms and Psychosocial Functioningmentioning

confidence: 99%

Section: Negative Symptoms and Psychosocial Functioningmentioning

confidence: 99%

Social Cognition, Negative Symptoms and Psychosocial Functioning in Schizophrenia

Madeira¹,

Caldeira²,

Bajouco³

et al. 2016

IJCNMH

View full text Add to dashboard Cite

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“…The presence of self‐reported psychotic‐like experiences (PEs), which do not reach the threshold for a diagnosable psychotic disorder, may be associated with an elevated risk for developing psychotic disorders in the future (Fusar‐Poli et al, 2013). However, limited evidence also suggests that PEs are associated with impacts on mood, functioning, and suicidality, indicating that these symptoms might carry wider implications for public mental health than for the development of psychosis alone (Armando et al, 2012; Fusar‐Poli et al, 2014; Kelleher et al, 2012a; Kelleher et al, 2014a; Yung et al, 2006).…”

Section: Introductionmentioning

confidence: 99%

A systematic review and meta‐analysis of mental health service use in people who report psychotic experiences

Bhavsar

McGuire

MacCabe

et al. 2017

Early Intervention Psych

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BackgroundSelf‐reported psychotic experiences (PEs) are associated with psychopathology of all kinds, not just psychoses. However, systematic reviews on the relevance of this for health services are unavailable. Furthermore, whether association with service use is confounded by other psychopathology is unknown, and is relevant to prevention and treatment.ObjectivesLiterature examining associations between PEs and service use was systematically reviewed. Study quality and the direction and extent of any associations were assessed, and meta‐analysis conducted.MethodsSystematic review and meta‐analysis was carried out as per PRISMA guidelines. A search of electronic databases was performed based on free‐text and structured terms. Included studies were evaluated by two raters using a structured tool and estimates extracted for reporting.ResultsThirteen studies were returned. We found two prospective studies, and a minority of studies accounted for concurrent psychopathology, limiting our ability to test our main hypotheses. Five studies reported associations by different types of service use. Almost all studies assessed service use by self‐report. Meta‐analysis suggested that people who reported PEs were around twice as likely to report service use compared to those who did not (pooled OR for all included studies: 2.20,95% confidence intervals (95%CI): 1.66,2.91).ConclusionsThere was consistent evidence of association between PEs and mental health service use at the general population level. However, evidence for causation was poor due to a limited number of studies. Whether increased service use in this group is solely attributable to PEs, and therefore whether interventions aimed at limiting/preventing PEs might be effective, requires studies focusing on the relationships between PEs, psychopathology and service use.

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“…Over the last two decades, specialised clinical services have been developed for people at high risk for psychosis 1, 2. Providing clinical care at this stage may reduce the risk of these individuals subsequently developing a psychotic disorder 3, 4.…”

Section: Introductionmentioning

confidence: 99%

Services for people at high risk improve outcomes in patients with first episode psychosis

Fusar‐Poli

Díaz‐Caneja

Patel

et al. 2015

Acta Psychiatr Scand

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ObjectiveAbout one‐third of patients referred to services for people at high risk for psychosis may have already developed a first episode of psychosis (FEP). We compared clinical outcomes in FEP patients who presented to either high risk or conventional mental health services.MethodRetrospective study comparing duration of hospital admission, referral‐to‐diagnosis time, need for compulsory hospital admission and frequency of admission in patients with FEP who initially presented to a high‐risk service (n = 164) to patients with FEP who initially presented to conventional mental health services (n = 2779). Regression models were performed, controlling for several confounders.Results FEP patients who had presented to a high‐risk service spent 17 fewer days in hospital [95% CI: −33.7 to (−0.3)], had a shorter referral‐to‐diagnosis time [B coefficient −74.5 days, 95% CI: −101.9 to −(47.1)], a lower frequency of admission [IRR: 0.49 (95% CI: 0.39–0.61)] and a lower likelihood of compulsory admission [OR: 0.52 (95% CI: 0.34–0.81)] in the 24 months following referral, as compared to FEP patients who were first diagnosed at conventional services.ConclusionServices for people at high risk for psychosis are associated with better clinical outcomes in patients who are already psychotic.

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The Psychosis High-Risk State

Cited by 1,215 publications

References 154 publications

Social Cognition, Negative Symptoms and Psychosocial Functioning in Schizophrenia

Social Cognition, Negative Symptoms and Psychosocial Functioning in Schizophrenia

A systematic review and meta‐analysis of mental health service use in people who report psychotic experiences

Services for people at high risk improve outcomes in patients with first episode psychosis

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