Elevated Risk For Psychosis Research Articles

Psychoeducation in Subjects at Elevated Risk for Psychosis - A Critical Review

Pychoeducation is a useful and required intervention in subjects with elevated-risk state of psychosis. Psychoeducation is, however, an under-investigated area in the field of early identification and prevention. Psychoeducation with this particular patient group needs to adapt to several unique features, e.g. the diagnostic uncertainty ("say it only in subjunctive") and problems of stigmatization. More research regarding the subjective psychoeducational needs of individuals at elevated risk for psychosis as well as more explicit provision and evaluation of psychoeducation in the elevated-risk state is strongly desirable.

Frühentwicklung kindlicher Schizophrenien

Childhood-onset schizophrenia (COS, age of onset between 7 and 14 years) is a rare and severe form of the disorder. The prevalence is about 1 / 50 of the rate of adult-onset schizophrenia. In COS-children emotional, cognitive and behavioural abnormalities are often seen years before illness onset. Premorbid symptoms including social withdrawal, isolation, introversion, peculiar behaviour, unmotivated temper tantrums, auto- and heteroaggressive acts, suicidal thoughts, anxiousness, paranoid ideas, represent early warning symptoms and are associated with an unfavourable outcome. About 60 % of 67 patients with COS examined by us (44 long-term-, 23 short-term-follow-up examinations) demonstrated premorbid abnormalities prior to the onset of their psychosis. We found a significant correlation between high M-PAS-scores, insidious onset, negative PANSS-Items, and early onset of age (< 12 years). High M-PAS-Scores were positively related to long duration of psychotic and residual states, and vice versa there was a negative correlation between M-PAS and a favourable outcome (long duration of recovery states). It is necessary to identify clinical states of elevated risk for psychosis as early as possible. This is difficult especially in young patients, in whom psychical peculiarities are ambiguous, and they may develop in different directions, most of them into normalization. Nevertheless, it is important to recognize risk-groups by time and to study their development carefully. Thus they could benefit from multiprofessional family-oriented early interventions.

Psychosis Risk Doesn't Drop in Second-Generation Immigrants

Back to table of contents Previous article Next article Clinical & Research NewsFull AccessPsychosis Risk Doesn't Drop in Second-Generation ImmigrantsMark MoranMark MoranSearch for more papers by this authorPublished Online:19 Dec 2008https://doi.org/10.1176/pn.43.24.0012The risk of psychosis among first- and second-generation immigrants to the United Kingdom appears to be similar.That's an important finding because it underscores the well-documented elevated risk for psychosis among immigrants and clarifies that the risk does not diminish depending on how long immigrant groups have been residing in the host country.The finding was from the East London First-Episode Psychosis Study and was reported in the November Archives of General Psychiatry.The study also supports the concept that the elevated risk is likely related to environmental factors.“This suggests that within ethnic groups, the cumulative effect—or load—of factors that serve to increase the risk of psychoses in black and minority ethnic groups is probably similar across generations, although the exact specification of these factors will probably differ,” wrote Jeremy Coid, M.D., and colleagues. “For example, the pressures faced by first-generation black Caribbean immigrants in the 1950s and 1960s were very different from those faced by their second-generation counterparts in the 1990s and beyond. Assuming for a moment that discrimination is a risk factor for psychoses in black and minority ethnic populations, our results support the notion that its cumulative effect is roughly similar across generations, although the form of discrimination has probably changed over generations.”Coid is with the Forensic Psychiatry Research Unit at St Bartholomew's Hospital, London.The study was a population-based epidemiological survey during a two-year period among 484 patients with first-episode psychosis in three inner-city boroughs of East London, England. The area is exclusively inner city, characterized by high levels of socioeconomic deprivation; historically, it has hosted a number of diverse ethnic groups who immigrated to the United Kingdom.All potential cases of psychosis presenting to psychiatric services for the first time (including adult community mental health teams, inpatient units, forensic services, learning disability services, adolescent mental health services, and drug and alcohol units) were screened. Patients were classified as being in one of six ethnic subgroups: white British, white other (predominantly Irish and European groups), black Caribbean (including black other, mixed white, and black Caribbean groups), black African, Asian (Indian, Pakistani, and Bangladeshi groups), and all other ethnic groups (Chinese, other Asian, and other mixed ethnic groups).Rates in each ethnic group were standardized using the 2001 census population of England and Wales stratified by sex and age.The researchers found higher incidence rates of both nonaffective and affective psychoses for all of the black and minority ethnic subgroups compared with white British individuals. The risk of nonaffective psychoses for first- and second-generations varied by ethnicity: only black Caribbean second-generation individuals were at significantly greater risk, compared with their first-generation counterparts.No significant differences between first and second generations were observed in other ethnic groups. Asian women but not men of both generations were at increased risk for psychoses, compared with white British individuals.The researchers postulated that the greater risk for second-generation black Carribean individuals may be due to the fact that the first-generation cohort in that ethnic group tends to be older than in the other groups and to have bypassed the period of 18-24 years of age, when individuals are at greatest risk of psychosis.“For other ethnic groups such as the black African and white other groups, where the modal age group in each generation was closer to the main period of risk of psychoses, the elevated risk of psychoses was comparable between first- and second-generation immigrants,” Coid and colleagues wrote.Ezra Susser, M.D., Dr.P.H., a researcher who has also studied psychosis among immigrant groups and who reviewed the report for Psychiatric News, said it adds to the picture of elevated risk for immigrant ethnic groups that has been reported in a number of studies.“It's further evidence that something in the socioeconomic environment is causing the increased risk,” Susser said. “And whatever it is has to be common across first- and second-generation immigrants.”He is a professor of epidemiology at Columbia University's Mailman School of Public Health and a professor of psychiatry at the New York State Psychiatric Institute.Susser was one of the lead investigators in a study showing that immigrants living in neighborhoods where their own ethnic group represents a very small proportion of the population are at increased risk for psychosis, a finding that points to the influence of social mechanisms—social networks, language fluency, stigma, discrimination and harassment, and other environmental and psychosocial factors—in the etiology of some cases of schizophrenia (Psychiatric News, February 1).An abstract of “Raised Incidence Rates of All Psychoses Among Migrant Groups: Findings From the East London First-Episode Psychosis Study” is posted at< http://archpsyc.ama-assn.org/cgi/content/abstract/65/11/1250>.“ Ethnic Density of Neighborhoods and Incidence of Psychotic Disorders Among Immigrants” is posted at < http://ajp.psychiatryonline.org/cgi/content/full/165/1/66>.▪ ISSUES NewArchived

Multicenter linkage study of schizophrenia loci on chromosome 22q.

The hypothesis of the existence of one or more schizophrenia susceptibility loci on chromosome 22q is supported by reports of genetic linkage and association, meta-analyses of linkage, and the observation of elevated risk for psychosis in people with velocardiofacial syndrome, caused by 22q11 microdeletions. We tested this hypothesis by evaluating 10 microsatellite markers spanning 22q in a multicenter sample of 779 pedigrees. We also incorporated age at onset and sex into the analysis as covariates. No significant evidence for linkage to schizophrenia or for linkage associated with earlier age at onset, gender, or heterogeneity across sites was observed. We interpret these findings to mean that the population-wide effects of putative 22q schizophrenia susceptibility loci are too weak to detect with linkage analysis even in large samples.

Apolipoprotein-E (APO-E) Genotype and Symptoms of Psychosis in Alzheimer's Disease

The authors examined the association of Apolipoprotein-E (APO-E) genotype to symptoms of psychosis and depression in 501 patients diagnosed with probable (n=343) or possible (n=158) Alzheimer's disease (AD) according to NINCDS-ADRDA criteria. They observed the following APO-E genotypes: epsilon2/epsilon3 (n=19); epsilon2/epsilon4 (n=14); epsilon3/epsilon3 (n=228); epsilon3/epsilon4 (n=203); epsilon4/epsilon4 (n=37). In contrast to previous reports, the results did not indicate a relationship between either the epsilon4 allele or the epsilon2 allele and symptoms of mood disturbance in AD. However, an elevated risk for psychosis was shown, specifically, at the severe stage of cognitive impairment, among AD patients carrying the epsilon4 allele, after effects of age, gender, education, and level of cognitive impairment were controlled.

Personal resourcefulness: positive aspects of functioning in high-risk research.

This paper discusses theoretical and measurement issues involved in attaining a differentiated picture of the distribution of outcomes in subjects selected for their elevated risk for psychosis; these outcomes include positive adaptations as well as subtle expressions of psychopathology. Many at-risk subjects either do not break down or actually "prosper" in the face of risk factors, a problem that persists even when risk groups are defined with increasing selectivity. Although this phenomenon is often referred to as the problem of "false positives" in risk research, its implications are more far-reaching than simply defining a problem of low yield in prospective studies.

Impulsive nonconformity as a trait contributing to the prediction of psychotic-like and schizotypal symptoms.

A 51-item true-false Impulsive Nonconformity Scale was constructed to measure impulsive antisocial behavior of the sort often reported in the premorbid adjustment of some psychotics. Schizophrenics and schizoaffective patients (N = 46) scored higher on the scale than control (N = 76). An experimental group of 120 aberrantly high-scoring (2 SDs above the mean) college students and 176 control subjects were interviewed using modified versions of Weissman and Paykel's Social Adjustment Scale interview and Spitzer and Endicott's Schedule for Affective Disorders and Schizophrenia-Lifetime Version (SADS-L). The experimental subjects reported more antisocial and nonconforming behaviors than control subjects, supporting the construct validity of the scale as a measure of impulsive nonconformity, and reported more psychotic or psychotic-like experiences, more schizotypal experiences, and more depressive and manic or hypomanic symptoms, suggesting that a portion of the experimental subjects may be at elevated risk for psychosis and/or major affective disorder. Subjects who score aberrantly high on both the Impulsive Nonconformity Scale and our earlier Perceptual Aberration-Magical Ideation Scale are more aberrant on several other measures of schizophrenic-like cognitive slippage than are subjects who score high on only one of the two scales.

The longitudinal research base for early intervention

The question is raised whether there is a sound empirical research basis for early identification of psychoses and active efforts to prevent them or moderate their severity. Retrospective evidence is presented for historical continuity of deviance in the lives of many psychotic adults. Two promising avenues of early intervention are discussed. One focuses on the children of psychotic parents, who are known to have an elevated risk for psychosis. The other is directed at emotionally deviant children in public schools. Major obstacles to effective social action toward these aims are considered, the most forbidding confronting prospective intervention in the public schools. Recommendations for action by mental health professionals are offered.