RESUMEN
AIMS: The present study aimed to examine the structure of the Prodromal Questionnaire-16 (PQ-16) in a non-help-seeking youth population through exploratory and confirmatory factor analysis. Previous studies have not examined the structure of this self-report measure in this age group outside a clinical setting. METHODS: Participants (n = 1165) aged 11-19 years were recruited to an epidemiological study of young people in Northern Ireland, and completed the PQ-16 alongside other measures. The dataset was split randomly in two for separate factor analyses. A polychoric correlation matrix was created and exploratory factor analysis was used to identify the optimal number of factors. In addition, based on previous studies, six models were tested through confirmatory factor analysis to determine best fit. A one-factor, 3 two-factor, a three-factor and a four-factor model were all tested. RESULTS: The exploratory factor analysis indicated a two-factor structure of the PQ-16 in this population, which we have labelled 'general unusual experiences' and 'hallucinations'. Confirmatory analysis indicated that the two-factor model identified through the exploratory analysis was the best fit for the data. DISCUSSION: The present study suggests that the structure of the PQ-16 may vary across age groups in non-clinical settings, and adds further support to the validity of the PQ-16 is a cost-effective, easy to administer self-report measure that is suitable for use in non-help-seeking populations as a screening tool for prodromal symptoms.
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Trastornos Psicóticos , Humanos , Adolescente , Trastornos Psicóticos/diagnóstico , Reproducibilidad de los Resultados , Encuestas y Cuestionarios , Autoinforme , Análisis Factorial , Síntomas Prodrómicos , PsicometríaRESUMEN
OBJECTIVE: To establish the premorbid features in youth depression patients with attenuated symptoms of schizophrenia (ASS) and in a comparison group, with an analysis of the course of age crises, signs of personality disorders, level of premorbid functioning and their relationship with the level of functioning after five-year follow-up. MATERIAL AND METHODS: Two hundred and nineteen youth depression patients with ASS (according to ICD-10: F32.1, F32.2, F32.28, F32.8) (main group) and 52 patients with «pure¼ adolescent depression without ASS (comparison group) were examined. A total of 124 patients from the main group and 27 patients from the comparison group were examined in 5-year follow-up. The Perceptual Awareness Scale (PAS) was used to assess premorbid functioning and the Personal and Social Performance (PSP) scale was used to determine function at the time of the follow-up. The method of χ2 was used to analyze qualitative data. The correlation analysis was performed with Spearman's rank correlation coefficient. Results are presented as median values [Q1; Q3]. RESULTS: The main group of patients with ASS have worse psychopathological symptoms compared with the comparison group (χ2=4.74; p=0.029). Premorbid functioning was also lower in the period 12-15 years (0.4 [0.33; 0.5]) and 16-18 years (0.47 [0.385; 0.585]) than in the comparison group (0.3 [0.23; 0.43] and 0.37 [0.23; 0.462], respectively, (p<0.05)). Negative correlation has been established between average PAS scores in the age of 12-15 and 16-18 years and the five-year follow-up on the PSP scale (r=-0.276, p<0.05 and r=-0.359, p<0.05 respectively). CONCLUSION: Similar characteristics of the premorbid period in childhood and an increase in differences starting from the pubertal period reflect the pathogenetic significance of the pubertal crisis and suggest compensatory mechanisms that, in patients with youth depression with ASS, are able to restrain the development of the endogenous process for a certain time, but subsequently become exhausted, which leads to persistence of psychopathological symptoms in intercrisis periods and serves as the first clinical marker of the onset of schizophrenia.
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Depresión , Esquizofrenia , Psicología del Esquizofrénico , Adolescente , Humanos , Depresión/diagnóstico , Depresión/epidemiología , Esquizofrenia/epidemiología , Esquizofrenia/diagnóstico , Factores de TiempoRESUMEN
OBJECTIVE: To analyze main aspects of the treatment of patients with youth depression with attenuated schizophrenic symptoms (ASS). MATERIAL AND METHODS: Two hundred and nineteen young in-patients (median age 19.6±2.4) with the first depressive episode (F32.1, F32.2, F32.38, F32.8.) and ASS were examined. The comparison group included 52 patients with depression without ASS with similar socio-demographic and age characteristics (average age 19.8±2.7 years). The efficacy of the therapy was assessed by the reduction of HDRS, SOPS and SANS scores. The Drug Compliance Scale was used to assess the compliance of patients. RESULTS: The average duration of in-patient treatment did not differ between groups (56.3 days in the main group and 54.2 days in the comparison group). The most effective therapy was found in the depression reduction on HDRS (67.9% and 76.6% respectively), the ASS reduction was 46.1% on the SOPS and 31.2% on the SANS. The combination of antidepressants (46.0±28.9 mg/day for fluoxetine equivalents) and antipsychotics (385.4±210.7 mg/day for chlorpromazine equivalents) were required to achieve this efficacy. The average duration of continued treatment was 7.4±9.6 months that was significantly lower (p<0.05) than in the comparison group (11.7±9.0 months), which was determined by the low compliance of such patients. CONCLUSION: The results show that a combination treatment and the implementation of measures, increasing the degree of compliance are required to increase the efficacy of treatment in patients with youth depression and ASS.
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Antipsicóticos , Esquizofrenia , Adolescente , Adulto , Antidepresivos/uso terapéutico , Antipsicóticos/uso terapéutico , Depresión/diagnóstico , Depresión/tratamiento farmacológico , Humanos , Esquizofrenia/diagnóstico , Esquizofrenia/tratamiento farmacológico , Adulto JovenRESUMEN
AIMS: To examine the structure of the Prodromal Questionnaire (PQ-16) in a non-help-seeking population through exploratory factor analysis and confirmatory factor analysis. Previous studies have not looked at the structure of this self-report measure outside clinical settings. METHODS: Participants (n = 1045) were recruited through Amazon's Mechanical Turk (MTurk), and then completed the PQ-16. The data set was split randomly in two, one being used for exploratory factor analysis (EFA) and the other for confirmatory factor analysis (CFA). A polychoric correlation matrix was created and EFA was used to explore the factor structure of the PQ-16. Four models were tested through CFA to determine best fit: one, two, three and four-factor models were all analysed. RESULTS: EFA indicated a two-factor structure in the PQ-16 in a non-help-seeking population (with a mean age = 29.7 years). Factor 1 represented perceptual abnormalities/hallucinations and factor 2 general symptoms associated with psychosis-risk. CFA indicated that all the proposed models were suitable fits for the dataset. Fit indices for the three-factor model (factor 1 representing perceptual abnormalities/hallucinations, factor 2 unusual thought content, and factor 3 negative symptom) indicated that it appeared to be a better fit for the data than the one, two, and four factor models. CONCLUSIONS: This study suggests that a three-factor model of the PQ-16 is a better fit than other proposed models in a non-help-seeking population. Future research of the structure of the PQ-16 in this population may benefit from recruiting subjects with a lower mean age than the current study.
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Síntomas Prodrómicos , Adulto , Análisis Factorial , Humanos , Psicometría , Reproducibilidad de los Resultados , Encuestas y CuestionariosRESUMEN
AIM: The at-risk mental state (ARMS) allows clinicians to identify individuals who have an increased risk of developing psychosis. At present, most screening for psychosis-risk is carried out within help-seeking populations; however, screening within educational settings may allow clinicians to identify individuals at-risk earlier and to increase the rate of detection. This review aimed to examine screening for the ARMS in educational settings, with the key questions: what screening tools have been used in educational settings, can screening in educational settings detect individuals with ARMS, what threshold scores in screening tools indicate a positive screen in educational settings, are there comorbid mental health conditions associated with the ARMS in educational settings? METHODS: Searches were carried out in PsycINFO, MEDLINE, EMBASE, Scopus and Web of Science and reference lists of included articles searched. Results were summarized using narrative synthesis. RESULTS: Nine papers were included for narrative synthesis. A variety of screening tools have been used when screening for the ARMS in educational settings. The majority of studies have been conducted in schools. The prevalence of the ARMS reported in ranges from 1% to 8%. CONCLUSIONS: The ARMS indicates the presence of distressing symptoms for which intervention may be beneficial. Screening programmes within educational settings may allow outreach for prodromal symptoms at an earlier stage than clinical settings currently provided for.
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Tamizaje Masivo/métodos , Trastornos Psicóticos/diagnóstico , Instituciones Académicas , Humanos , Salud Mental , Síntomas Prodrómicos , Trastornos Psicóticos/psicología , Factores de RiesgoRESUMEN
AIM: This study aimed to examine the relationship between types of childhood adversity and attenuated psychotic symptoms in a general population sample, and to determine the predictive role of other psychosocial factors such as resilience, coping style and social support. METHODS: An online survey was conducted with a US-based general population sample of 748 participants (aged 18 to 35 years) using Amazon's Mechanical Turk (an online crowd-sourcing service). Participants completed the Adverse Childhood Experiences Questionnaire (ACE-Q), the Prodromal Questionnaire (PQ-16), the Brief COPE Scale, the Brief Resilience Scale (BRS), the Multidimensional Scale of Perceived Social Support and the Neighbourhood Cohesion Scale. A series of backwards stepwise hierarchical regression analyses was employed to determine the predictors of PQ-16 score. RESULTS: Participants reported an average of 2.99 attenuated psychotic symptoms (from a total of 16), and an average of 2.77 childhood adversities (from a total of 10). In the final model, the specific types of childhood adversity which significantly predicted PQ-16 score were verbal abuse, sexual abuse and physical neglect. Resilience, as well as the coping styles of self-distraction, denial, substance use, emotional support, venting, religion and self-blame, were significant predictors; perceived social support and neighbourhood cohesion were not. This model predicted 33% of the variance in PQ-16 score. CONCLUSIONS: The results of this study support the association between childhood adversity and attenuated psychotic symptoms in the general population. Resilience and coping styles were also important predictive factors. These data suggest potential strategies on which to focus for early intervention and prevention.
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Adaptación Psicológica , Experiencias Adversas de la Infancia , Trastornos Psicóticos/diagnóstico , Trastornos Psicóticos/psicología , Adolescente , Adulto , Niño , Empleo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Síntomas Prodrómicos , Psicometría/estadística & datos numéricos , Análisis de Regresión , Resiliencia Psicológica , Apoyo Social , Trastornos Relacionados con Sustancias , Encuestas y Cuestionarios , Adulto JovenRESUMEN
BACKGROUND: Much of the interest in youth at clinical high risk (CHR) of psychosis has been in understanding conversion. Recent literature has suggested that less than 25% of those who meet established criteria for being at CHR of psychosis go on to develop a psychotic illness. However, little is known about the outcome of those who do not make the transition to psychosis. The aim of this paper was to examine clinical symptoms and functioning in the second North American Prodrome Longitudinal Study (NAPLS 2) of those individuals whose by the end of 2 years in the study had not developed psychosis. METHODS: In NAPLS-2 278 CHR participants completed 2-year follow-ups and had not made the transition to psychosis. At 2-years the sample was divided into three groups - those whose symptoms were in remission, those who were still symptomatic and those whose symptoms had become more severe. RESULTS: There was no difference between those who remitted early in the study compared with those who remitted at one or 2 years. At 2-years, those in remission had fewer symptoms and improved functioning compared with the two symptomatic groups. However, all three groups had poorer social functioning and cognition than healthy controls. CONCLUSIONS: A detailed examination of the clinical and functional outcomes of those who did not make the transition to psychosis did not contribute to predicting who may make the transition or who may have an earlier remission of attenuated psychotic symptoms.
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Progresión de la Enfermedad , Síntomas Prodrómicos , Trastornos Psicóticos/epidemiología , Adolescente , Adulto , Femenino , Humanos , Estudios Longitudinales , Masculino , América del Norte/epidemiología , Remisión Espontánea , Riesgo , Adulto JovenRESUMEN
AIM: Diagnosing individuals at ultra high risk (UHR) for psychosis can improve early access to treatment, and a two-stage model utilizing self-report screening followed by a clinical interview can be accurate and efficient. However, it is currently unclear which screening cut-offs to adopt with different populations. METHODS: A systematic review of diagnostic accuracy studies evaluating the Prodromal Questionnaire (PQ) as a preliminary screener for UHR and psychosis was conducted to examine screening effectiveness in different contexts. MedLine, PsycInfo, SCOPUS and ProQuest Dissertations and Abstracts databases were electronically searched, along with a review screen and citation search of key papers. Findings were summarized in a narrative synthesis. RESULTS: In total, 14 diagnostic accuracy studies and 45 studies using the PQ as a screening tool for UHR and psychosis were included. In all settings, the 3 different versions of the PQ were all found to accurately identify UHR and full psychosis. Higher cut-off points were required in non-help-seeking samples, relative to general help-seeking populations, which in turn were higher than those needed in samples highly enriched with UHR participants. CONCLUSION: The findings support the use of the PQ as a preliminary screening tool for UHR in different settings; however, higher thresholds in lower UHR-prevalence populations are necessary to minimize false positives. Including the distress criteria, rather than just number of symptoms, may improve screening effectiveness. Different thresholds may be appropriate in different contexts depending on the importance of sensitivity vs specificity. Protocol registration: CRD42016033004.
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Síntomas Prodrómicos , Escalas de Valoración Psiquiátrica , Trastornos Psicóticos/diagnóstico , Trastornos Psicóticos/psicología , Humanos , Factores de Riesgo , Sensibilidad y EspecificidadRESUMEN
The proneness-persistence-impairment (PPI) model states that psychotic experiences are more likely to lead to impairment if their expression becomes persistent. Higher genetic risk for psychosis is known to affect proneness and persistence of subclinical positive symptoms. Less is known about potential effects of genetic risk on the course of subclinical negative symptoms, impairment, and their subsequent associations. The current study examined these issues in a large sample (n=1131), consisting of individuals with higher genetic risk (siblings of patients with psychotic disorders, n=703) and lower genetic risk (controls without a family member with lifetime psychosis, n=428). Psychotic experiences were assessed with the CAPE questionnaire, at two time points three years apart. Participants were allocated to one of four groups representing developmental course: stable low, decreasing, increasing or persisting subclinical positive/negative symptoms. Lifetime clinical psychosis was an exclusion criterion at baseline. Higher genetic risk status was found to be associated with a persisting course of both subclinical positive and negative symptoms, symptom-related distress and functional impairment. There is no evidence for an effect of genetic risk status on the association between developmental course and impairment. The results of the current study underline the importance of assessing psychotic experiences in the context of genetic risk, multidimensional and over time. Additionally, the current findings both underscore and contribute to the PPI model: psychotic experiences are more likely to lead to impairment if their expression becomes persistent, both in individuals with higher and lower genetic risk for psychosis.
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Predisposición Genética a la Enfermedad , Trastornos Psicóticos/genética , Trastornos Psicóticos/psicología , Hermanos/psicología , Adulto , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Estudios Longitudinales , Masculino , Modelos Genéticos , Modelos Psicológicos , Fenotipo , Escalas de Valoración Psiquiátrica , Conducta Social , Encuestas y CuestionariosRESUMEN
Despite the wealth of evidence linking duration of untreated psychosis to critical illness outcomes, most clinicians do not utilize any formal evaluation tools to identify attenuated or emerging psychotic symptoms. Given the costs associated with training and administration, interview-based assessments such as the Structured Interview for Psychosis Risk Syndromes (SIPS) are not likely to be widely adopted for clinical use. The ability to identify high-risk individuals through low-cost, brief methods is essential to the success of scalable prevention efforts. The aim of this article is to present a comprehensive review of the use of self-report forms as psychosis risk "screeners." A literature search revealed 34 investigations in which authors used a self-report questionnaire as a first-step screener in a clinical high-risk assessment protocol. Information about each screener, including reported psychometric data, is presented within the review. Psychosis risk screeners have been used in diverse samples with the goals of validating assessments, screening populations for clinical referral, recruiting samples of interest for research participation, and estimating symptom prevalence and severity. Screeners focusing on attenuated psychotic experiences appear to measure a reliable construct with variable prevalence in help-seeking and general population samples. Administration of screeners to help-seeking populations can identify enriched samples with substantially elevated likelihood of meeting CHR criteria and transitioning to psychosis over time. More research is needed, however, to establish reliable norms and screening thresholds, as score elevations indicating a likely high-risk respondent appear to be unreliable across populations and settings.