What drives poor functioning in the at-risk mental state? A systematic review

Cotter, Jack; Drake, Richard; Bucci, Sandra; Firth, Joseph; Edge, Dawn; Yung, Alison R.

doi:10.1016/j.schres.2014.09.012

Cited by 104 publications

(81 citation statements)

References 113 publications

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“…This aspect of our results is consistent with previous studies (Addington et al, 2015, Carrion et al, 2013, Nelson et al, 2012, Nelson et al, 2013, Thompson et al, 2013) and emphasizes the importance of considering functioning in the clinical management of people at UHR for psychosis (Cotter et al, 2014). In addition, the observation that disorder of thought content, intensity of attenuated psychotic symptoms and functioning made independent contributions to prediction, suggests that these three aspects reflect independent rather than overlapping processes along the pathway to psychosis.…”

Section: Discussionsupporting

confidence: 93%

“…Recent studies (Addington et al, 2015, Cannon et al, 2008, Cotter et al, 2014, Lencz et al, 2006, Michel et al, 2014, Nieman et al, 2014) suggest that greater levels of accuracy, sensitivity and specificity could be achieved through the integration of psychopathological measures with other types of data. For example, it is possible to refine prediction of transition to psychosis by combined psychopathological information with measures of genetic risk (Thompson et al, 2013), years of education (Ruhrmann et al, 2010), substance abuse (Thompson et al, 2013), sleep disturbances (Ruhrmann et al, 2010), premorbid adjustment (Nieman et al, 2014), cognitive impairment (Lencz et al, 2006, Michel et al, 2014, Riecher-Rossler et al, 2009) and neurophysiology (Nieman et al, 2014).…”

Section: Discussionmentioning

confidence: 99%

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Using clinical information to make individualized prognostic predictions in people at ultra high risk for psychosis

Mechelli

Lin

Wood

et al. 2017

Schizophrenia Research

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Recent studies have reported an association between psychopathology and subsequent clinical and functional outcomes in people at ultra-high risk (UHR) for psychosis. This has led to the suggestion that psychopathological information could be used to make prognostic predictions in this population. However, because the current literature is based on inferences at group level, the translational value of the findings for everyday clinical practice is unclear. Here we examined whether psychopathological information could be used to make individualized predictions about clinical and functional outcomes in people at UHR. Participants included 416 people at UHR followed prospectively at the Personal Assessment and Crisis Evaluation (PACE) Clinic in Melbourne, Australia. The data were analysed using Support Vector Machine (SVM), a supervised machine learning technique that allows inferences at the individual level. SVM predicted transition to psychosis with a specificity of 60.6%, a sensitivity of 68.6% and an accuracy of 64.6% (p < 0.001). In addition, SVM predicted functioning with a specificity of 62.5%, a sensitivity of 62.5% and an accuracy of 62.5% (p = 0.008). Prediction of transition was driven by disorder of thought content, attenuated positive symptoms and functioning, whereas functioning was best predicted by attention disturbances, anhedonia–asociality and disorder of thought content. These results indicate that psychopathological information allows individualized prognostic predictions with statistically significant accuracy. However, this level of accuracy may not be sufficient for clinical translation in real-world clinical practice. Accuracy might be improved by combining psychopathological information with other types of data using a multivariate machine learning framework.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Using clinical information to make individualized prognostic predictions in people at ultra high risk for psychosis

Mechelli

Lin

Wood

et al. 2017

Schizophrenia Research

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“…Moreover, poor functioning is likely to be entrenched prior to the manifestation of full-threshold psychotic symptoms (Cotter et al 2014). Criteria have been developed to identify individuals vulnerable to developing a psychotic disorder (Yung et al 1996(Yung et al , 1998Miller et al 2002;Yung et al 2005).…”

Section: Psychotic Disordersmentioning

confidence: 99%

Childhood trauma and functional disability in psychosis, bipolar disorder and borderline personality disorder: a review of the literature

Cotter

Kaess

Yung

2014

Ir. j. psychol. Med.

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Objectives. We aimed to examine the association between childhood trauma and functional impairment in psychotic disorders, bipolar disorder and borderline personality disorder, to speculate on possible mechanisms that underlie this association and discuss the implications for clinical work.Methods. Narrative review of the peer-reviewed English language literature in the area.Results. High rates of childhood trauma in psychotic disorders, bipolar disorder and borderline personality disorder were identified. This was associated with impaired social and occupational functioning in both the premorbid and established phases of each of these psychiatric disorders over and above the deficits typically observed in these populations. Possible mechanisms mediating this relationship include neurocognitive deficits, insecure attachment, higher rates of comorbidities and problems with adherence and response to treatment. Conclusions.Routine clinical inquiry about childhood maltreatment should be adopted within mental health settings. This has potentially important treatment implications for identifying those individuals at elevated risk of functional disability. While there is no clear guidance currently available on how to target childhood trauma in the treatment of psychotic disorders, bipolar disorder or borderline personality disorder, there are several promising lines of enquiry and further research is warranted.

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“…This was developed based on a systematic review of the UHR functioning research literature and the clinical expertise of the research team (Cotter et al, 2014). Each interview lasted between 30 and 45 minutes, was audiorecorded and subsequently transcribed verbatim.…”

Section: Qualitative Interviewsmentioning

confidence: 99%

“…UHR group. These have received comparatively little attention in previous studies investigating functioning in the UHR group.Based on the themes derived from this study and previous quantitative research(Cotter et al, 2014;Yung et al, 2015), we have proposed a model that attempts to highlight the main factors driving functional impairment in the UHR group(Figure 1). Self-stigmatizing and dysfunctional metacognitive beliefs also emerged as themes and were frequently cited as barriers to engaging in social and vocational activities.…”

mentioning

confidence: 99%

Exploring functional impairment in young people at ultra‐high risk for psychosis: A qualitative study

Cotter

Bucci

Drake

et al. 2018

Early Intervention Psych

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What drives poor functioning in the at-risk mental state? A systematic review

Cited by 104 publications

References 113 publications

Using clinical information to make individualized prognostic predictions in people at ultra high risk for psychosis

Using clinical information to make individualized prognostic predictions in people at ultra high risk for psychosis

Childhood trauma and functional disability in psychosis, bipolar disorder and borderline personality disorder: a review of the literature

Exploring functional impairment in young people at ultra‐high risk for psychosis: A qualitative study

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