精神病高危综合征人群的心理理论特征

目的：探讨精神病高危综合征人群的心理理论特征。方法共纳入140名受试者,其中高危组70名,与之匹配的健康对照70名,分别对两组受试者进行功能大体评定（GAF）、失言觉察任务（FPT）、眼神阅读任务（RMET）评估,比较两组人群心理理论的差异。结果在GAF中,高危组和对照组当前GAF得分（t＝－32．79,P＜0．01）及GAF减分值（t＝27．99,P＜0．01）的差异有统计学意义;在FPT中,高危组的失言故事识别、失言故事理解和对照故事识别得分均低于对照组,差异有统计学意义（P＜0．01）;在RMET中,与对照组相比,高危组的反应时间延迟、反应准确率下降,差异均有统计学意义（P＜0．01）。结论精神病高危综合征人群存在心理理论能力受损。     

Voxel-wise meta-analysis of fMRI studies in patients at clinical high risk for psychosis

Background

Reliable neurofunctional markers of increased vulnerability to psychosis are needed to improve the predictive value of psychosis risk syndrome and inform preventive interventions.

Methods

I performed a signed differential mapping (SDM) voxel-wise meta-analysis of functional magnetic resonance imaging (fMRI) studies of patients at clinical high risk for psychosis.

Results

Ten studies were included in the analysis. Compared with controls, high-risk patients showed reduced neural activation in the left inferior frontal gyrus (Brodmann area [BA] 9) and in a cluster spanning the bilateral medial frontal gyrus (BA 8,6), bilateral superior frontal gyrus (BA 8,6) and the left anterior cingulate (BA 32). There was no publication bias. Heterogeneity across studies was low. Sensitivity analysis confirmed the robustness of the findings.

Limitations

The cross-sectional nature of the included studies prevented the comparison of high-risk patients who later experienced a psychotic episode with those who did not. Other caveats are reflected in methodologic heterogeneity across tasks employed by different individual imaging studies.

Conclusion

Reduced neurofunctional activation in prefrontal regions may represent a neurophysiologic correlate of increased vulnerability to psychosis.     

Theory of mind performance and prefrontal connectivity in adolescents at clinical high risk for psychosis

Theory of mind(ToM) impairment is a key feature of psychotic disorders and has been documented in individuals at clinical high-risk for psychosis (CHR), suggesting that it may predate illness onset. However, no study to date has examined brain functional correlates of ToM in individuals at CHR during adolescence. The “Reading-the-Mind-in-the-Eyes” test was used to measure ToM performance in 50 CHR youth, 15 of whom transitioned to psychosis (CHR-t) at follow-up (12 ± 6 months) and 36 healthy volunteers. Resting-state functional MRI was acquired to evaluate functional connectivity within the default mode network. Group by age interaction revealed an age-positive association in ToM performance in healthy volunteers, which was not present in adolescents at CHR-t. Intrinsic functional connectivity in the medial prefrontal cortex was reduced in adolescents at CHR-t relative to those who did not transition and to healthy volunteers. Survival analyses revealed that participants at CHR with lower medial prefrontal cortex connectivity were at greatest risk of developing psychosis at follow-up. We demonstrate that lack of age-related maturation of ToM and reduced medial prefrontal cortex connectivity both precede the onset of psychosis during adolescence. Medial prefrontal cortex connectivity holds potential as a brain-based marker for the early identification of transition to psychosis.     

Social functioning in individuals at clinical high risk for psychosis

Poor social functioning is a hallmark of schizophrenia. The purpose of this study was to examine social functioning in individuals at clinical high risk for psychosis. Social functioning was assessed in a sample of 86 clinical high risk (CHR) individuals and compared to that of 50 first-episode of psychosis (FE) subjects, 53 multi-episode schizophrenia subjects (ME) and 55 non-psychiatric controls (NPC). Subjects were assessed on the Social Functioning Scale (SFS), the Role Functioning subscale of the Quality of Life Scale (QLS-role), and the premorbid functioning scale. On the SFS, the CHR group did not differ significantly from the FE and ME groups and all were impaired relative to the NPCs. On QLS-role, the CHR group performed significantly better than the ME patients and significantly worse than NPCs. CHR subjects did not differ from patients in terms of premorbid functioning. This study demonstrates that even at the pre-psychotic phase of the illness, these young people are demonstrating significant deficits in social functioning, supporting that social deficits are present long before the onset of psychotic symptoms.     

从心理理论能力看精神病高危综合征人群转归

目的探讨精神病高危综合征人群临床转归与其心理理论(theory of mind,To M)特征的关系。方法利用前驱期综合症结构式访谈(structured interview for psychosis-risk syndromes,SIPS)和前驱期综合症量表(scale of psychosis-risk symptoms,SOPS)筛选出精神病高危综合征(clinical high risk,CHR)者90例,用失言觉察任务(faux pas test,FPT)、眼神阅读测试(reading the mind in the eyes text,RMET)评估CHR者心理理论特征。进行为期2年随访,利用SIPS确定临床转归,根据精神病转归情况将CHR者分为转化组(20例)和未转化组(50例),对两组基线水平临床症状特征、FPT、RMET结果进行分析,比较其心理理论的差异。结果两组CHR者在基线水平临床症状差异无统计学意义(P0.05);在FPT中,两组CHR失言故事识别得分、失言故事理解得分和失言任务总分存在统计学差异(P0.05),在对照故事识别得分上无统计学差异(P0.05);两组RMET各结果无统计学差异(P0.05)。结论精神病高危人群心理理论能力受损严重个体精神病转化的风险更高。     

Treating young individuals at clinical high risk for psychosis

Background: Typically, studies investigating those at clinical high risk for psychosis have focused on predictors of conversion and treatments that might prevent conversion to full‐blown psychosis. Few studies have followed those who do not go on to develop a psychotic illness. Methods: Participants were 48 young people who were at risk for developing psychosis based on the Structured Interview for Prodromal Symptoms criteria and participated in a treatment programme where they were offered up to 6 months of psychosocial treatment and psychiatric management. Attenuated psychotic symptoms, negative symptoms, depression, anxiety, social functioning, alcohol and drug use, and meta‐cognitive beliefs were assessed at baseline, 6, 12 and 18 months. Personality characteristics were assessed at baseline. Medication use was tracked and psychiatric visits were logged over the 18‐month study period. Results: On average, participants attended 12 sessions of psychosocial treatment and had one meeting with the psychiatrist every 6 months. Only 24% were ever prescribed any psychotropic medications, and antipsychotics were not used. Significant improvements were found over time in attenuated positive symptoms, negative symptoms, depression, anxiety, meta‐cognitions and social functioning with most improvement occurring in the first 6 months. There was no change in the level of substance use. For personality assessment, participants generally scored high on neuroticism and openness and had low scores on extraversion, agreeableness and conscientiousness. Conclusion: With minimal treatment and no antipsychotics, young people who present as being at risk for developing a psychotic disorder demonstrate clinical improvement over time. However, a few continued to have the liability of ongoing attenuated psychotic symptoms.     

Treatment possibilities for individuals at clinical high risk of psychosis

Aim: The purpose of this study was to undertake a first step in trying to understand the types of treatments young people at clinical high risk of psychosis are interested in pursuing. Methods: The sample consisted of 30 young people who were current participants in the ongoing North American Prodrome Longitudinal Study (NAPLS 2) and who met criteria for being at clinical high risk for psychosis. Participants were administered a questionnaire that asked them to identify the types of mental health problems they were currently getting help with or would like to get help with and the types of treatments they thought would be helpful and may be interested in receiving. Results: Results showed that when individuals first began participation in NAPLS, almost half had no expectations for treatment. They wanted help but they did not really know what kind of help to be asking for. Participants had a wide range of concerns for which they wanted help. Although a majority endorsed attenuated positive symptoms as a concern, many other issues such a family and social problems were often identified. For those who were already receiving help, the general opinion was that it was beneficial. Conclusions: The findings suggest that this population sees many different interventions as being potentially helpful. Furthermore, they are open to participating in a variety of treatments, including psychotherapeutic and psychiatric interventions as well as more general treatments addressing a range of possible deficits or difficulties.     

Predictors of study drop-out and service disengagement in patients at clinical high risk for psychosis

Social Psychiatry and Psychiatric Epidemiology - Study drop-out during follow-up and service disengagement frequently occur in patients at clinical high risk for psychosis (CHR-P). However, little...     

Facial affect recognition in individuals at clinical high risk for psychosis

Facial affect discrimination and identification were assessed in 86 clinical high-risk individuals and compared with 50 individuals with first-episode psychosis, 53 with multi-episode schizophrenia and 55 non-psychiatric controls. On the identification task the non-psychiatric controls performed significantly better than all other groups, and on discrimination significantly better than both patient groups. Deficits in facial affect recognition appear to be present before the onset of psychosis and may be a vulnerability marker.     

Social network size in adolescents at clinical high risk for psychosis

Aims

Adolescents and young adults at clinical high risk (CHR) for psychosis report few close friends. Social support has been linked to conversion to psychosis and psychosis relapse in CHR individuals. Expanding earlier research on loneliness and friendships at a single timepoint, this study described composition and changes in social network and its association with clinical and cognitive symptoms among CHR adolescents.

Methods

Ninety five individuals (46 CHR individuals, 49 healthy volunteers) completed baseline and 1-year follow-up Social Network Index (SNI) evaluations and clinical interviews. Analyses first examined SNI size and composition across 10 categories (e.g., family, close friends, coworkers, classmates) between groups. Then, the relationship between SNI size and baseline social symptoms (i.e., paranoia, social anhedonia, social anxiety, social cognition), social function, and changes in symptoms and social networks over 1-year were examined within the CHR group.

Results

CHR individuals showed smaller social networks overall, driven by fewer friendships and family relationships. Social cognition and social anxiety significantly related to SNI size at baseline, but social anhedonia and paranoia did not. SNI size related to social function, but with a modest effect size (r's = .45 and .56). Surprisingly, an increase in positive symptom severity related to an increase in familial but a decrease in coworker social network size.

Conclusions

The social support deficits in the CHR group were specific to relatives and friendships, with social anxiety and social cognition as implicated symptoms. Social relationships may serve as a promising early intervention target in individuals at CHR for psychosis.