Studies in adolescents on ultra-high risk (UHR) and basic symptoms (BS) criteria for psychosis prediction are scarce. In Italy, early interventions in psychosis are less widespread than in other ...European countries. In the present study, we (1) assessed the clinical relevance of a UHR diagnosis according to the comprehensive assessment of at-risk mental states (CAARMS) criteria to promote the implementation of specific services for UHR adolescents into the Italian health care system; (2) described severity of positive, negative, general, and basic symptoms in UHR adolescents compared to adolescents with first-episode psychosis (FEP) and non-UHR adolescents (i.e., individuals who did not meet CAARMS criteria for UHR or FEP); and (3) investigated the predictive validity of UHR criteria in relation to BS criteria. Seventy-nine adolescents (aged 13–18 years) were assessed with the CAARMS, the positive and negative syndrome scale (PANSS), and the schizophrenia proneness instrument, child and youth version (SPI-CY). Both UHR (
n
= 25) and FEP (
n
= 11) had significantly higher PANSS subscale scores compared to non-UHR (
n
= 43). UHR had significantly lower PANSS-positive symptom scores than FEP, but similar global functioning and PANSS-negative symptoms and general psychopathology scores. Compared to non-UHR, both FEP and UHR had more severe thought and perception BS disturbances, and significantly more often met BS criteria. After 12 months, 2 of 20 (10%) UHR had transitioned to psychosis. They also met both BS criteria. Given the uncertain outcome of UHR adolescents, future research is needed to determine whether the combined assessment of BS with UHR symptoms can improve the accuracy of psychosis prediction in adolescence.
The clinical significance and the prognostic value of clinical high risk (CHR) for psychosis, while substantially corroborated in adults, remains less firmly established in children and early ...adolescents. This follow-up study, developed within the Reggio Emilia At Risk Mental States project, is meant to contribute to the reduction of such lacuna, and has two main aims: (1) to characterize the clinical profile of help seekers stratified in non-CHR, CHR and first episode psychosis (FEP) referred to child–adolescent mental health services; and (2) to monitor the cumulative transition rate from CHR to FEP in adolescents at the follow-up of 12 and 24 months. 112 adolescents (aged 13–18 years) were assessed with the Comprehensive Assessment of At-Risk Mental States and the Schizophrenia Proneness Instrument, Child and Youth version. 51 subjects met CHR criteria (45.5% of the sample) and 33 subjects met FEP criteria (29.5%) at baseline. The criterial transition rate from CHR to FEP was 7% over 12 months and 13% over 24 months; higher rates of cumulative transition were detected when also functional transition (indexed by the consensual introduction of antipsychotic medication by the treating clinical staff) was considered. The identification of CHR for psychosis in help-seeking adolescents is feasible and clinically relevant. Studies conducted in real world, publicly funded components of the national health system, should take into consideration not only criterial, psychometric transition, but also functional equivalents of transition.
Objective
Suicide risk in subjects at Ultra‐High Risk of psychosis (UHR) has been rarely assessed in adolescence, but it is of obvious importance for prognostic and clinical care reasons. In this ...study, we aimed to prospectively assess suicide risk and behaviors in UHR adolescents.
Method
We examined 112 help‐seeking adolescents (13–18 years, 50% males, 83.9% Caucasian) that were enrolled in the Reggio Emilia At‐Risk Mental States (ReARMS) project and followed up for 2 years. Specific items derived from the Comprehensive Assessment of At‐Risk Mental States (CAARMS) and the Beck Depression Inventory‐II (BDI‐II) were used to assess suicide risk. Suicide attempts and completed suicides were also recorded.
Results
Baseline assessment detected 40 UHR adolescents, 32 FEP (first‐episode psychosis), and 40 non‐UHR/FEP. We found that 67.5% of UHR adolescents had suicidal ideation, and 18.5% to severe degree. Attempted suicide before enrollment was higher in the UHR group than in non‐UHR/FEP peers (17.5% vs. 2.5%). BDI‐II suicidal ideation severity was stable at 12‐month follow‐up and decreased at 24‐month follow‐up.
Conclusions
A high prevalence of suicidal ideation among UHR adolescents was found and supports the routine monitoring of risk of self‐injurious thinking and behavior in this at‐risk population.
Aim
Early intervention in psychosis (EIP) can reduce severity and persistence of illness. From September 2012, the Reggio Emilia Department of Mental Health developed the ‘Reggio Emilia At‐Risk ...Mental States’ (ReARMS) protocol as a specific EIP infrastructure in all its adult and child/adolescent mental health services. Aims of this study were (a) to describe the ReARMS macroscopic organization and (b) to analyse some specific process indicators (i.e., the amount of individuals referred to the ReARMS program, the number of subjects who met defined diagnostic criteria of early psychosis and accepted the intervention, and the 1‐year drop‐out rate) during the first 5 years of its clinical activity, in order to examine feasibility and quality of its procedures on the adolescent help‐seeking subgroup.
Methods
Adolescent participants (n = 125), aged 13–18 years, completed the Comprehensive Assessment of At‐Risk Mental States (CAARMS) to investigate the clinical status. Descriptive quantitative analyses were then used.
Results
Fifty (40%) individuals did not meet early psychosis‐defined criteria, while 75 (60%: i.e., 44 Ultra‐High Risk UHR and 31 First Episode Psychosis FEP subjects) were offered an EIP dedicated care protocol: of them, 66 (88%) were enrolled in the program and 9 (12%) dropped out during the first year of treatment). Adolescents enrolled in the ReARMS protocol were mainly referred by general practitioners (32%), family members (16%), or school/social services (15.2%). Seventy (56%) participants had a history of previous specialist contact (especially for learning and anxiety disorders).
Conclusions
An EIP program for adolescents with early psychosis in Italian child/adolescent mental health services are feasible, clinically relevant and recommended, specifically in this age group with a high risk of falling through the child/adult service gap.
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.
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
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.
Aim
Identifying discrete dimensions that underline negative symptoms in First Episode Psychosis (FEP) could improve the understanding and the treatment of such invalidating symptomatology. The aim of ...this study is to examine the negative symptom structure in FEP individuals and to compare the resulting factor configurations between FEP subjects with and without Schizophrenia Spectrum Disorders (SSD vs non‐SSD).
Methods
One hundred and seventy participants (88 SSD and 82 non‐SSD), aged 13–35 years, completed the Comprehensive Assessment of At‐Risk Mental States (CAARMS) and the Positive and Negative Syndrome Scale (PANSS). A principal component analysis was then performed to investigate PANSS negative symptom structure in both non‐SSD and SSD groups.
Results
Whereas in the SSD sample a 3‐factor model solution (i.e., “Socio‐Emotional Disengagement”, “Motor/Thought Poverty”, and “Avolition/Apathy” dimensions) was identified, a 2‐factor model solution (with a mixed alogia/avolition domain in addition to a mixed socio‐emotional disengagement/expressive deficits dimension) appeared more appropriate in the non‐SSD group.
Conclusions
Our results show a relevant difference in the negative symptom factor structure between SSD and non‐SSD individuals. In particular, a different specificity and significance of negative symptom models in FEP populations with diagnoses other than schizophrenia (compared to those with SSD) must be realistically considered. Notably, a “Motor/Thought Poverty” domain, which specifically includes alogia and motor retardation separately from the other PANSS negative items, appears to specifically characterize FEP young patients with the schizophrenia spectrum.
Abstract The aim of the study was to evaluate psychometric properties of the Obsessive Compulsive Inventory (OCI) on Italian community and clinical samples. The Italian version of the 42-item OCI was ...administered to a sample of 340 individuals belonging to the general population and to 88 patients with obsessive compulsive (OCD) or other anxiety disorders. Four different internal structures of the OCI were compared through confirmatory factor analysis (CFA): the figures for the model with six factors and 18 items (OCI-R) met the best criteria for adequacy of fit. The six scales showed on average a 10% of common variance in the community sample and 8% in the clinical sample. The OCI-R subscales showed good internal consistency and temporal stability, with the exception of washing and mental neutralizing subscales which showed a strong alpha coefficient only in the OCD sample. Psychometric data for the OCI-R were insensitive to age and sex, whereas an effect of education was found. Concurrent validity was demonstrated, since the OCI-R subscales showed a pattern of specific correlations with another conceptually related self-report measure. Moreover, although the OCI-R was positively correlated with measures of depression, anxiety, and worry, the correlations were weaker than those with the other measure of OCD symptoms. The OCI-R clearly differentiated OCD patients from non-OCD anxious patients and nonclinical controls with the exception of hoarding subscale. However, the hoarding scale discriminated OCD patients who presented hoarding symptoms from OCD counterparts without such symptoms. Thus, the OCI-R proved to be a reliable and valid measure of obsessive compulsive symptoms in the Italian context.
Aim
The 16‐item Prodromal Questionnaire (PQ‐16) is a versatile screen tool for routine screening of at‐risk individuals. We wished to evaluate the psychometric properties of the Italian version of ...the PQ‐16 (iPQ‐16) in a sample of 72 help‐seeking adolescents (age range 13‐17 years) referred to child and adolescent neuropsychiatry services for diagnostic assessment.
Methods
Participants who completed iPQ‐16 were subsequently interviewed with the Comprehensive Assessment of At‐Risk Mental States (CAARMS) to confirm the psychosis high risk state. We then examined the diagnostic accuracy (sensitivity, specificity, positive and negative predictive values PPV e NPV) and concurrent validity between iPQ‐16 and CAARMS using Cronbach's alpha and Cohen's kappa. We also tested the validity of the adopted iPQ‐16 cut‐offs through Receiver Operating Characteristic (ROC) curves plotted against CAARMS diagnoses and the 1‐year predictive validity of the iPQ‐16.
Results
Overall, the psychometric properties of the iPQ‐16 were satisfactory. The iPQ‐16 showed high internal consistency (Cronbach's alpha = .827) and acceptable diagnostic accuracy (77% sensitivity, 72% PPV) and concurrent validity (Cohen's k = 0.309). ROC analyses pointed to iPQ‐16 total distress score of ≥10 as best cut‐off.
Conclusion
The iPQ‐16 is a reliable and valid instrument for routine screening of at‐risk individuals in Italian neuropsychiatry services.
