Aim
From September 2012, the Reggio Emilia Department of Mental Health developed a specific program (the “Reggio Emilia At‐Risk Mental States” ReARMS protocol) as a diffused, “liquid” infrastructure ...for early intervention in psychosis. Aims of the current study are (a) to describe the ReARMS macroscopic organization and (b) to examine specific process indicators during the first 5 years of clinical activity.
Methods
All participants (n = 300) were young help‐seekers, aged 13 to 35 years, who completed the Comprehensive Assessment of At‐Risk Mental States (CAARMS).
Results
At baseline, 95 (31.7%) participants did not meet CAARMS‐defined criteria, while 205 (68.3%) were offered a dedicated protocol of care: 154 (75.1%) of them were enrolled in the program, 19 (9.3%) refused and 32 (15.6%) dropped out during the first year of treatment. Individuals enrolled in the ReARMS protocol were mainly referred by general practitioners (33.3%), emergency room/general hospital (24%) or they were self‐referred (15%). In comparison with ultra‐high risk individuals, patients with first episode psychosis showed significantly higher mean age at entry and preponderance of males, as well as higher percentages of history of substance abuse and previous hospitalization.
Conclusions
An early intervention in psychosis service in Italian child/adolescent and adult mental health services are feasible and clinically relevant, also in adolescents, who have a high risk of falling through the child‐adult service gap as they cross the transition boundary between services.
Disorganization is a crucial domain in affective psychoses. However, it has received poor research attention, especially at the illness onset. The aims of this study were: (a) to monitor the ...longitudinal course of disorganization in young people with first episode affective psychosis (FEAP) across 2 years of follow-up, and (b) to investigate any relevant correlation of disorganized symptoms with psychopathology, functioning and the specific treatment elements of an "Early Intervention in Psychosis" (EIP) protocol along the follow-up period.
Seventy-five FEAP participants (aged 12-35 years) completed the Positive And Negative Syndrome Scale (PANSS) and the Global Assessment of Functioning (GAF). Spearman's rank correlation coefficients were calculated.
During the follow-up, disorganized symptoms showed significant enduring positive correlations with PANSS items representing delusional thought content and uncooperativeness, as well as a persistent negative association with the GAF score. Across the 2-year follow-up period, FEAP individuals also had a relevant reduction in disorganization levels. This symptom decrease was specifically related with the combination of antipsychotic medication with the specific psychosocial components of our EIP intervention offered to FEAP patients during the first 12 months of treatment.
Disorganization is relevant in FEAP subjects already at their enrollment in specialized EIP protocols. However, it decreases over time, together with the delivery of specific, combined (person-tailored) EIP interventions.
Aim
Suicide risk is greater at the beginning of the course of psychosis. Purpose of this research was: (a) to investigate prevalence and incidence rates of suicide attempts, suicidal thinking and ...completed suicide in First Episode Psychosis (FEP) help‐seekers as compared with non‐FEP help‐seeking peers, and (b) to examine any correlation of suicidal ideation with other baseline psychopathological predictors.
Methods
Two hundred and forty‐one young people (13‐35 years) were assessed with the World Health Organization Quality Of Life scale ‐ Brief version (WHOQOL‐BREF), the Beck Depression Inventory ‐ II Edition (BDI‐II) and the Comprehensive Assessment of At‐Risk Mental States (CAARMS) at the enrollment and over a 36‐month follow‐up period. A Kaplan‐Meier survival analysis to calculate cumulative incidence rates of attempted and completed suicide was used.
Results
FEP patients showed more severe levels of CAARMS “Suicidality/Self‐Harm” item than non‐FEP peers. They also had higher 3‐year incidence rates of attempted suicide (11%) and completed suicide (13%). Within the FEP total group, suicidal ideation was positively correlated with BDI‐II and CAARMS “Perceptual Abnormalities” item scores, and showed negative associations with younger age and WHOQOL‐BREF “Social Relationships” factor sub‐score.
Conclusions
Suicidal ideation is relevant in FEP patents, supporting the routine monitoring of suicide risk in baseline assessment of adolescents and young adults with early psychosis. Suicidal thinking seems to be correlated to younger age, perceptual aberrations and depression severity, as well as to poorer quality of social relationships.
Borderline Personality Disorder (BPD) is under-investigated in First Episode Psychosis (FEP). BPD psychotic manifestations and mood changes are also difficult to differentiate from first episode ...affective psychosis. The aim of this study was to compare sociodemographic and clinical features between FEP patients with BPD vs. Bipolar Disorder (BD) or Major Depressive Disorder (MDD) both at baseline and across a 2-year follow-up period.
224 FEP participants (49 with BPD, 93 with BD and 82 with MDD) completed the Health of the Nation Outcome Scale (HoNOS), the Positive And Negative Syndrome Scale (PANSS) and the Global Assessment of Functioning (GAF) scale. Psychiatric diagnosis was reformulated at the end of our follow-up. Inter-group comparisons were analyzed using the Kruskal-Wallis or the Chi-square test. A mixed-design ANOVA model was also performed to assess the temporal stability of clinical scores within and between the 3 subgroups.
Compared to FEP/BD subjects at baseline, FEP/BPD patients showed higher depressive symptom severity and lower excitement severity. Compared to FEP/MDD at entry, they had a higher prevalence rate of substance abuse, a lower interpersonal impairment and a shorter DUP. Finally, they had a lower treatment response on HoNOS “Psychiatric Symptoms” subscale scores across the follow-up in comparison with both FEP/BD and FEP/MDD individuals.
BPD as categorical entity represents a FEP subgroup with specific clinical features and treatment response. Appropriate treatment guidelines for this FEP subgroup are thus needed.
Impairments in SC have been reported in people at Ultra-High Risk (UHR) of psychosis exclusively using neurocognitive tasks. The aims of this study are (1) to assess subjective experience of SC in ...adolescent and young adult community help-seekers identified through UHR criteria, (2) to explore significant associations of SC with psychopathology and functioning in UHR individuals; and (3) to monitor longitudinally the SC stability after a 2-year follow-up period. Methods: Participants (97 UHR, 141 First-Episode Psychosis FEP, and 98 non-UHR/FEP), aged 13-35 years, completed the Comprehensive Assessment of At-Risk Mental States (CAARMS) and the GEOPTE scale of social cognition for psychosis. Within the UHR group, a multiple linear regression analysis (with GEOPTE scores as independent variables and CAARMS dimension subscores and treatment measures as dependent variables) was also performed across the 2-year longitudinal design. Results: In comparison with non-UHR/FEP, both UHR and FEP subjects showed significantly higher GEOPTE scores. Both after 12 and 24 months of follow-up, UHR individuals had a significant decrease in severity on GEOPTE SC subscore. In the UHR group, GEOPTE scores showed significant positive correlations with general psychopathology, positive and negative symptoms. Regression analysis showed a significant contribution of SC in predicting baseline social isolation, impaired role functioning, and general psychopathology. After 1 year of follow-up, improvement in SC was predicted by the number of psychotherapy sessions and lower doses of antipsychotics. Conclusions: SC deficits are prominent in UHR individuals and are similar in severity to those of FEP patients. However, they tend to decrease over time along with the delivery of targeted, specialized interventions for early psychosis.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Objectives
Aberrant salience (AS) has a crucial role in the onset of psychosis. The Aberrant Salience Inventory (ASI) is the only self‐report instrument specifically developed for the assessment of ...AS. Aim of this study was to examine the reliability and the validity of the approved Italian version of the ASI in a clinical sample of young help‐seekers.
Methods
The ASI was completed by 204 individuals, aged 13–35 years. Reliability was assessed examining internal consistency and test‐retest reliability. Concordant validity was established with CAARMS (“Comprehensive Assessment of At‐Risk Mental States”).
Results
The ASI showed high test‐retest reliability and excellent internal consistency. The ASI total score had significant positive correlations with CAARMS “Positive Symptoms” subscores.
Conclusions
The ASI showed satisfactory psychometric properties and seems to be a suitable instrument for early detection of psychosis in Italian mental health services.
Although aberrant salience (AS) is a putative vulnerability factor in schizophrenia, empirical research on AS in early stages of psychosis is currently relatively scarce (especially as regards on its ...longitudinal course and treatment response in adolescence). The aim of the present study was to longitudinally monitor the stability of AS along a 1‐year follow‐up period in an Italian population of community help‐seeking adolescents with First Episode Psychosis (FEP) or at Ultra‐High Risk (UHR) of psychosis and to examine any relevant association of AS with specific treatment components of a specialized “Early Intervention in Psychosis” (EIP) program across the 1 year of follow‐up.
Participants (38 FEP, 42 UHR), aged 13–18 years, completed the Comprehensive Assessment of At‐Risk Mental States (CAARMS) and the Aberrant Salience Inventory (ASI) both at baseline and at the end of the follow‐up period. Spearman's correlations between AS scores and specific EIP treatment components were performed.
After the 1 year of follow‐up, both FEP and UHR adolescents showed a statistically significant reduction in AS levels. In FEP patients, this was correlated to the number of psychoeducational sessions provided to their family members. In the UHR subgroup, this AS decrease was associated with the number of individual Cognitive‐Behavioral Therapy (CBT) sessions directly offered to help‐seeking adolescents.
AS is relevant both in FEP and UHR adolescents already at the enrollment in specialized EIP programs. However, its longitudinal levels decrease over time, together with the delivery of specific psychosocial EIP interventions.
Aim of the study
The aims of this investigation were: (1) to calculate baseline prevalence of FES patients with relevant depressed mood (DM), (2) to longitudinally monitor DM levels over a 12-month ...follow-up, and (3) to investigate their associations with clinical data and the specific treatment components of an “Early Intervention in Psychosis” (EIP) program.
Subject or material and methods
The Positive And Negative Syndrome Scale (PANSS) was completed by all FES participant. Individuals with a baseline PANSS “Depression” item subscore of ≥ 5 were classified as having relevant depressed mood (FES/DM+). Chi-square and Mann-Whitney tests were used for inter-group comparisons. A linear regression analysis was also performed.
Results
Fifty-three (33.3%) participants were in the FES/DM+ subgroup. Relevant baseline DM at baseline was associated with female gender and a higher PANSS “Positive Symptoms” score. Across the follow-up, FES individuals improved their DM levels. This was significantly related to a longitudinal decrease in PANSS “Positive Symptoms” levels.
Discussion
More than 1/3 of FES subjects had relevant DM already at the recruitment time in an EIP service. This suggests that relevant depression in FES subjects is usually under-treated. Moreover, we observed a significant decrease in DM severity levels across the follow-up. This decrease was associated with the longitudinal severity reduction in positive symptom levels, reflecting their state-related fluctuations.
Conclusions
DM is relatively frequent in FES, already at the recruitment in EIP services. However, its severity decreases overtime within specialized EIP programs.
Aim: Previous research observed deficits in pleasure experience in chronic schizophrenia, but little is known about anhedonia in early psychosis. Aim of this study is: (1) to examine anhedonia in ...distinct help-seeking subgroups of young people identified through the First Episode Psychosis (FEP) criteria, (2) to investigate its correlations with psychopathology in the FEP sample, and (3) to monitor longitudinally its stability in the FEP group along 1-year follow-up period.
Materials and methods: All participants (137 FEP and 95 nonpsychotic psychiatric controls i.e. non-FEP), aged 13-35 years, completed the Comprehensive Assessment of At-Risk Mental States (CAARMS), the Schizotypal Personality Questionnaire - Brief version (SPQ-B), the Brief O-LIFE questionnaire (BOL), and the World Health Organization Quality of Life - Brief version (WHOQOL-BREF). We used two different indexes of anhedonia: CAARMS 'Anhedonia' item 4.3 and BOL 'Introvertive Anhedonia' subscale scores.
Results: In comparison with non-FEP, FEP patients showed higher baseline anhedonia scores. After 1-year follow-up period, FEP individuals had a significant decrease in severity of anhedonia scores. In the FEP group, anhedonia showed significant, enduring (over time) correlations with impaired role functioning, negative symptoms, comorbid depression, poorer self-perceived quality of life and specific schizotypal personality traits (i.e. interpersonal deficits).
Conclusions: Anhedonia is relevant in the early phase of psychosis and its severity is associated with functioning deterioration and a bad quality of life.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Aim
Aberrant salience (AS) is considered a putative predisposing factor for the onset of psychosis. However, despite several studies conducted in the general population, research in early psychosis ...is still relatively scarce. The main purposes of this study were to investigate any relevant correlation of AS with functioning and psychopathology in young patients with first episode psychosis (FEP), and to analyse the longitudinal stability of AS across a 1 year follow‐up period.
Methods
All the participants (139 FEP), aged 13–35 years, completed the Aberrant Salience Inventory (ASI), the Comprehensive Assessment of At‐Risk Mental States (CAARMS), and the Positive And Negative Syndrome Scale (PANSS). Spearman correlation analysis among psychopathological parameters were performed both at baseline and after the 1 year of follow‐up.
Results
Across the follow‐up, FEP patients showed a significant decrease in the ASI total score. This reduction was specifically associated with the number of individual cognitive‐behavioural therapy sessions offered to FEP individuals in the same time period (and not with antipsychotic dose at baseline).
Conclusions
AS is clinically significant in FEP patients. However, it tends to ameliorate over time together with the delivery of specialized, person‐tailored FEP treatments within a specific “Early Intervention in Psychosis” protocol.
