Background: Although the first two years of a psychotic disorder are a period of particularly hig... more Background: Although the first two years of a psychotic disorder are a period of particularly high risk, it takes an average of 1.5 years for young people to start treatment following the onset of psychotic symptoms. Screening for psychosis in primary care may help to close this treatment gap, but there is debate on whether or not to screen all youth. Opponents argue that the risks posed to false positives are too high, and no age-appropriate psychosis screens have been developed for this population. The current study pilot tested questions for an adolescent psychosis screen and compares its overlap with the Patient Health Questionnaire (PHQ-9), a depression screen commonly given in primary care settings. Methods: The Screening for Early & Emerging Mental Experiences (SEE-ME) screen is a 23-item scale assessing recent psychotic-like experiences. It queries all major symptom domains of psychosis at a 6th grade reading level, as well as frequency and distress of these symptoms. Recruitment of youth ages 14-21 is ongoing in an adolescent primary care clinic at Boston Children’s Hospital. An independent 2-tailed t test examined the relationship between distress on SEE-ME and PHQ-9 scores that would and would not be flagged for mental health follow-up. An ANOVA examined the relationship between distress and history of mental health treatment. Results: Positive responses to SEE-ME questions were fairly common, with 32% endorsing 5 or more items. PHQ-9 and SEE-ME distress scores were closely related, with those who would be flagged for mental health follow-up showing significantly higher distress on SEE-ME (t = -5.3, df = 10.4, p\u3c0.001). However, some psychosis-spectrum items (ex. paranoia) were less commonly endorsed by those with high PHQ-9 scores. We found no significant relationship between engagement in therapy and SEE-ME distress (F=2.62, p=0.11). Conclusions: Though uncommon, there is a subset of youth for whom their psychotic-like experiences are distressing and untreated. Patients at risk for psychosis who do not have depression-like symptoms may not be flagged by the PHQ-9 or other existing screens. This key population is likely to benefit from screening
Background: The relationship between sleep and psychosis is well-established, with sleep disturba... more Background: The relationship between sleep and psychosis is well-established, with sleep disturbances being one of the earliest signs of an emerging psychotic disorder. Those at clinical high-risk (CHR) for psychosis are known to experience more fragmented sleep, which in turn increases the severity of psychotic and mood symptoms. Experience sampling is a useful method through which to understand the relationship between sleep and daily fluctuations in mood and psychosis. A better understanding of these within-day symptom dynamics may clarify the role of sleep in clinical trajectories for at-risk youth. Thus, this study used a phone app to capture real-time symptom changes alongside Fitbit & self-reported sleep monitoring to characterize symptom dynamics in early & emerging psychosis. Methods: 34 adolescents at CHR or in the early stages of a psychotic disorder completed daily surveys about their mood & experiences. Using experience sampling methods, participants received 6 semi-random surveys each day over the course of 3 weeks via a mobile phone app and wore a Fitbit to measure activity & sleep. Sleep duration and quality were calculated for all participants and compared against data from healthy controls (n=15). Moment-to-moment changes in mood were also calculated for all participants and compared across diagnostic groups. Multi-level linear and logistic regressions of affect variability and psychosis were conducted to demonstrate the effect of sleep on these symptoms. Results: We report results within and across diagnostic groups on sleep, affect variability, and psychotic symptoms. Psychosis-spectrum individuals were more likely to report poorer sleep quality (F= 3.57, p=0.04) and less time asleep (F=4.86, p=0.01) than controls. Poorer sleep quality was moderately correlated with negative affect (r=-0.40). Conclusions: Experience sampling via mobile phone apps is a uniquely effective method to monitor sleep as it relates to moment-to-moment symptom changes among those with early and emerging psychosis. These data may better characterize the role of sleep in early psychosis and present sleep as a potential treatment target to improve clinical trajectories
Purpose: Although there is recent skepticism about whether affect dynamics offer added value over... more Purpose: Although there is recent skepticism about whether affect dynamics offer added value over mean levels of negative affect in differentiating between individuals, there has been little research examining the relationship of affect variability (AV) and psychotic symptoms within individuals (day-to-day). The purpose of these analyses was to explore the relationship of affect dynamics to psychotic experiences in individuals at clinical high risk (CHR) for psychosis or within five years of the onset of a psychotic disorder (PSY). Methods: We collected experience-sampling data from CHR and PSY patients ages 15-25. Up to 6 times per day, participants rated positive and negative emotions and attenuated psychotic symptoms (PS) on a 7-point Likert scale from “Not at all” to “Very much”. AV was calculated with moment-to-moment mean squared successive differences (MSSD). We conducted multilevel linear regression to test the relationship of AV and PS averaged at the daily level. Results: Preliminary analyses (n = 27, 13 male, m age = 19.9, sd = 2.4) suggest that daily negative AV is significantly associated with mean daily PS, even controlling for same day mean negative AV and PS on the previous day. Negative AV measured at the person level is associated with anxiety and bipolar disorder but not depressive or psychotic diagnoses. Conclusions: Affect dynamics may offer incremental value over mean affect levels in understanding symptom trajectories during the early phases of psychotic disorders. We will present analyses of a larger sample and additional assessments of symptom dynamics
Early identification and intervention is a gold standard for psychotic disorders, for which delay... more Early identification and intervention is a gold standard for psychotic disorders, for which delays in care can have serious consequences. Screening for psychosis in primary care may circumvent barriers related to stigma and facilitate shorter pathways to care. Yet, there is debate regarding the benefit-risk balance for psychosis screening in general adolescent populations. Primary care patients of an adolescent/young adult medical clinic in the US ages 14-21 self-administered surveys assessing age, sex, receipt of psychotherapy, and occurrence, frequency (1-5), and distress (0-3) for 23 psychosis risk (PR) symptoms, including 6 general/nonspecific items and 17 psychosis-specific items. Participants also completed the 9-item Patient Health Questionnaire (PHQ-9); scores of ≥10 suggested clinically significant depressive symptoms. Analyses characterized PR symptoms and examined associations of PR symptom distress with current therapy and depressive symptom severity. Of 212 patients who completed the survey, 75% endorsed ≥1 PR symptom and 27% rated ≥3 on distress for psychosis-specific items. Those with high PHQ-9 scores reported higher PR distress overall (t = -6.1, df = 52.3, p < 0.001) but not on psychosis-specific items such as hallucinations and suspiciousness. One in 9 participants reported heightened PR distress without being in therapy or having high depressive symptoms. Most adolescents in this primary care sample endorsed symptoms associated with PR. Distress related to these symptoms was less common but occurred even in the absence of depressive symptoms. PR screening only in youth with high depressive symptom screens or in mental health care may miss youth needing further assessment for psychosis.
AIM Successful delivery of care to individuals with early psychosis depends on the ability of com... more AIM Successful delivery of care to individuals with early psychosis depends on the ability of community providers to identify and refer appropriate candidates for services. Although specialty centres commonly rely upon education and outreach campaigns to building bridges with community providers, few studies have examined the effectiveness of these campaigns or the mechanisms by which they may achieve their intended effects. METHODS We surveyed community clinicians (N = 39) about their screening behaviours, referral practices, and confidence in managing early psychosis just before and 3-6 months after attending an educational event designed to promote recognition and quality treatment of early psychosis. RESULTS Three to six months following attendance, providers reported screening a greater proportion of clients for early psychosis, referring a greater number of clients to specialty services, and feeling more confident in their ability to respond to clients with early psychosis. Increases in confidence following attendance were associated with corresponding increases in screening behaviour. CONCLUSIONS The results suggest that outreach campaigns designed to enhance community providers' knowledge about early psychosis assessment and resources may be effective in promoting screening, referrals, and confidence in managing psychosis. Gains in provider confidence may contribute to increases in screening. Given the lack of control group and relatively short follow-up period, more research is needed to determine the effects of early psychosis educational events and the mechanisms by which they may promote successful treatment delivery for young people in need.
BackgroundOnly 30% or fewer of individuals at clinical high risk (CHR) convert to full psychosis ... more BackgroundOnly 30% or fewer of individuals at clinical high risk (CHR) convert to full psychosis within 2 years. Efforts are thus underway to refine risk identification strategies to increase their predictive power. Our objective was to develop and validate the predictive accuracy and individualized risk components of a mobile app-based psychosis risk calculator (RC) in a CHR sample from the SHARP (ShangHai At Risk for Psychosis) program.MethodIn total, 400 CHR individuals were identified by the Chinese version of the Structured Interview for Prodromal Syndromes. In the first phase of 300 CHR individuals, 196 subjects (65.3%) who completed neurocognitive assessments and had at least a 2-year follow-up assessment were included in the construction of an RC for psychosis. In the second phase of the SHARP sample of 100 subjects, 93 with data integrity were included to validate the performance of the SHARP-RC.ResultsThe SHARP-RC showed good discrimination of subsequent transition to psyc...
Epidemiology and psychiatric sciences, Jan 8, 2016
Chinese psychiatrists have gradually started to focus on those who are deemed to be at 'clini... more Chinese psychiatrists have gradually started to focus on those who are deemed to be at 'clinical high-risk (CHR)' for psychosis; however, it is still unknown how often those individuals identified as CHR from a different country background than previously studied would transition to psychosis. The objectives of this study are to examine baseline characteristics and the timing of symptom onset, help-seeking, or transition to psychosis over a 2-year period in China. The presence of CHR was determined with the Structured Interview for Prodromal Syndromes (SIPS) at the participants' first visit to the mental health services. A total of 86 (of 117) CHR participants completed the clinical follow-up of at least 2 years (73.5%). Conversion was determined using the criteria of presence of psychotic symptoms (in SIPS). Analyses examined baseline demographic and clinical predictors of psychosis and trajectory of symptoms over time. Survival analysis (Kaplan-Meier) methods along wit...
Background: Although the first two years of a psychotic disorder are a period of particularly hig... more Background: Although the first two years of a psychotic disorder are a period of particularly high risk, it takes an average of 1.5 years for young people to start treatment following the onset of psychotic symptoms. Screening for psychosis in primary care may help to close this treatment gap, but there is debate on whether or not to screen all youth. Opponents argue that the risks posed to false positives are too high, and no age-appropriate psychosis screens have been developed for this population. The current study pilot tested questions for an adolescent psychosis screen and compares its overlap with the Patient Health Questionnaire (PHQ-9), a depression screen commonly given in primary care settings. Methods: The Screening for Early & Emerging Mental Experiences (SEE-ME) screen is a 23-item scale assessing recent psychotic-like experiences. It queries all major symptom domains of psychosis at a 6th grade reading level, as well as frequency and distress of these symptoms. Recruitment of youth ages 14-21 is ongoing in an adolescent primary care clinic at Boston Children’s Hospital. An independent 2-tailed t test examined the relationship between distress on SEE-ME and PHQ-9 scores that would and would not be flagged for mental health follow-up. An ANOVA examined the relationship between distress and history of mental health treatment. Results: Positive responses to SEE-ME questions were fairly common, with 32% endorsing 5 or more items. PHQ-9 and SEE-ME distress scores were closely related, with those who would be flagged for mental health follow-up showing significantly higher distress on SEE-ME (t = -5.3, df = 10.4, p\u3c0.001). However, some psychosis-spectrum items (ex. paranoia) were less commonly endorsed by those with high PHQ-9 scores. We found no significant relationship between engagement in therapy and SEE-ME distress (F=2.62, p=0.11). Conclusions: Though uncommon, there is a subset of youth for whom their psychotic-like experiences are distressing and untreated. Patients at risk for psychosis who do not have depression-like symptoms may not be flagged by the PHQ-9 or other existing screens. This key population is likely to benefit from screening
Background: The relationship between sleep and psychosis is well-established, with sleep disturba... more Background: The relationship between sleep and psychosis is well-established, with sleep disturbances being one of the earliest signs of an emerging psychotic disorder. Those at clinical high-risk (CHR) for psychosis are known to experience more fragmented sleep, which in turn increases the severity of psychotic and mood symptoms. Experience sampling is a useful method through which to understand the relationship between sleep and daily fluctuations in mood and psychosis. A better understanding of these within-day symptom dynamics may clarify the role of sleep in clinical trajectories for at-risk youth. Thus, this study used a phone app to capture real-time symptom changes alongside Fitbit & self-reported sleep monitoring to characterize symptom dynamics in early & emerging psychosis. Methods: 34 adolescents at CHR or in the early stages of a psychotic disorder completed daily surveys about their mood & experiences. Using experience sampling methods, participants received 6 semi-random surveys each day over the course of 3 weeks via a mobile phone app and wore a Fitbit to measure activity & sleep. Sleep duration and quality were calculated for all participants and compared against data from healthy controls (n=15). Moment-to-moment changes in mood were also calculated for all participants and compared across diagnostic groups. Multi-level linear and logistic regressions of affect variability and psychosis were conducted to demonstrate the effect of sleep on these symptoms. Results: We report results within and across diagnostic groups on sleep, affect variability, and psychotic symptoms. Psychosis-spectrum individuals were more likely to report poorer sleep quality (F= 3.57, p=0.04) and less time asleep (F=4.86, p=0.01) than controls. Poorer sleep quality was moderately correlated with negative affect (r=-0.40). Conclusions: Experience sampling via mobile phone apps is a uniquely effective method to monitor sleep as it relates to moment-to-moment symptom changes among those with early and emerging psychosis. These data may better characterize the role of sleep in early psychosis and present sleep as a potential treatment target to improve clinical trajectories
Purpose: Although there is recent skepticism about whether affect dynamics offer added value over... more Purpose: Although there is recent skepticism about whether affect dynamics offer added value over mean levels of negative affect in differentiating between individuals, there has been little research examining the relationship of affect variability (AV) and psychotic symptoms within individuals (day-to-day). The purpose of these analyses was to explore the relationship of affect dynamics to psychotic experiences in individuals at clinical high risk (CHR) for psychosis or within five years of the onset of a psychotic disorder (PSY). Methods: We collected experience-sampling data from CHR and PSY patients ages 15-25. Up to 6 times per day, participants rated positive and negative emotions and attenuated psychotic symptoms (PS) on a 7-point Likert scale from “Not at all” to “Very much”. AV was calculated with moment-to-moment mean squared successive differences (MSSD). We conducted multilevel linear regression to test the relationship of AV and PS averaged at the daily level. Results: Preliminary analyses (n = 27, 13 male, m age = 19.9, sd = 2.4) suggest that daily negative AV is significantly associated with mean daily PS, even controlling for same day mean negative AV and PS on the previous day. Negative AV measured at the person level is associated with anxiety and bipolar disorder but not depressive or psychotic diagnoses. Conclusions: Affect dynamics may offer incremental value over mean affect levels in understanding symptom trajectories during the early phases of psychotic disorders. We will present analyses of a larger sample and additional assessments of symptom dynamics
Early identification and intervention is a gold standard for psychotic disorders, for which delay... more Early identification and intervention is a gold standard for psychotic disorders, for which delays in care can have serious consequences. Screening for psychosis in primary care may circumvent barriers related to stigma and facilitate shorter pathways to care. Yet, there is debate regarding the benefit-risk balance for psychosis screening in general adolescent populations. Primary care patients of an adolescent/young adult medical clinic in the US ages 14-21 self-administered surveys assessing age, sex, receipt of psychotherapy, and occurrence, frequency (1-5), and distress (0-3) for 23 psychosis risk (PR) symptoms, including 6 general/nonspecific items and 17 psychosis-specific items. Participants also completed the 9-item Patient Health Questionnaire (PHQ-9); scores of ≥10 suggested clinically significant depressive symptoms. Analyses characterized PR symptoms and examined associations of PR symptom distress with current therapy and depressive symptom severity. Of 212 patients who completed the survey, 75% endorsed ≥1 PR symptom and 27% rated ≥3 on distress for psychosis-specific items. Those with high PHQ-9 scores reported higher PR distress overall (t = -6.1, df = 52.3, p < 0.001) but not on psychosis-specific items such as hallucinations and suspiciousness. One in 9 participants reported heightened PR distress without being in therapy or having high depressive symptoms. Most adolescents in this primary care sample endorsed symptoms associated with PR. Distress related to these symptoms was less common but occurred even in the absence of depressive symptoms. PR screening only in youth with high depressive symptom screens or in mental health care may miss youth needing further assessment for psychosis.
AIM Successful delivery of care to individuals with early psychosis depends on the ability of com... more AIM Successful delivery of care to individuals with early psychosis depends on the ability of community providers to identify and refer appropriate candidates for services. Although specialty centres commonly rely upon education and outreach campaigns to building bridges with community providers, few studies have examined the effectiveness of these campaigns or the mechanisms by which they may achieve their intended effects. METHODS We surveyed community clinicians (N = 39) about their screening behaviours, referral practices, and confidence in managing early psychosis just before and 3-6 months after attending an educational event designed to promote recognition and quality treatment of early psychosis. RESULTS Three to six months following attendance, providers reported screening a greater proportion of clients for early psychosis, referring a greater number of clients to specialty services, and feeling more confident in their ability to respond to clients with early psychosis. Increases in confidence following attendance were associated with corresponding increases in screening behaviour. CONCLUSIONS The results suggest that outreach campaigns designed to enhance community providers' knowledge about early psychosis assessment and resources may be effective in promoting screening, referrals, and confidence in managing psychosis. Gains in provider confidence may contribute to increases in screening. Given the lack of control group and relatively short follow-up period, more research is needed to determine the effects of early psychosis educational events and the mechanisms by which they may promote successful treatment delivery for young people in need.
BackgroundOnly 30% or fewer of individuals at clinical high risk (CHR) convert to full psychosis ... more BackgroundOnly 30% or fewer of individuals at clinical high risk (CHR) convert to full psychosis within 2 years. Efforts are thus underway to refine risk identification strategies to increase their predictive power. Our objective was to develop and validate the predictive accuracy and individualized risk components of a mobile app-based psychosis risk calculator (RC) in a CHR sample from the SHARP (ShangHai At Risk for Psychosis) program.MethodIn total, 400 CHR individuals were identified by the Chinese version of the Structured Interview for Prodromal Syndromes. In the first phase of 300 CHR individuals, 196 subjects (65.3%) who completed neurocognitive assessments and had at least a 2-year follow-up assessment were included in the construction of an RC for psychosis. In the second phase of the SHARP sample of 100 subjects, 93 with data integrity were included to validate the performance of the SHARP-RC.ResultsThe SHARP-RC showed good discrimination of subsequent transition to psyc...
Epidemiology and psychiatric sciences, Jan 8, 2016
Chinese psychiatrists have gradually started to focus on those who are deemed to be at 'clini... more Chinese psychiatrists have gradually started to focus on those who are deemed to be at 'clinical high-risk (CHR)' for psychosis; however, it is still unknown how often those individuals identified as CHR from a different country background than previously studied would transition to psychosis. The objectives of this study are to examine baseline characteristics and the timing of symptom onset, help-seeking, or transition to psychosis over a 2-year period in China. The presence of CHR was determined with the Structured Interview for Prodromal Syndromes (SIPS) at the participants' first visit to the mental health services. A total of 86 (of 117) CHR participants completed the clinical follow-up of at least 2 years (73.5%). Conversion was determined using the criteria of presence of psychotic symptoms (in SIPS). Analyses examined baseline demographic and clinical predictors of psychosis and trajectory of symptoms over time. Survival analysis (Kaplan-Meier) methods along wit...
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