Hostname: page-component-848d4c4894-pftt2 Total loading time: 0 Render date: 2024-06-03T11:27:29.431Z Has data issue: false hasContentIssue false
  • English
  • Français

Dynamic association of the first identifiable symptom with rapidity of progression to first-episode psychosis

Published online by Cambridge University Press:  20 September 2021

Vincent Paquin Open the ORCID record for Vincent Paquin [Opens in a new window] ,
Lani Cupo ,
Ashok K. Malla ,
Srividya N. Iyer ,
Ridha Joober  and
Jai L. Shah
Vincent Paquin
Affiliation:
Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Québec, Canada Department of Psychiatry, McGill University, Montreal, Québec, Canada
Lani Cupo
Affiliation:
Integrated Program in Neuroscience, McGill University, Montreal, Québec, Canada
Ashok K. Malla
Affiliation:
Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Québec, Canada Department of Psychiatry, McGill University, Montreal, Québec, Canada
Srividya N. Iyer
Affiliation:
Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Québec, Canada Department of Psychiatry, McGill University, Montreal, Québec, Canada
Ridha Joober
Affiliation:
Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Québec, Canada Department of Psychiatry, McGill University, Montreal, Québec, Canada
Jai L. Shah*
Affiliation:
Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Québec, Canada Department of Psychiatry, McGill University, Montreal, Québec, Canada Integrated Program in Neuroscience, McGill University, Montreal, Québec, Canada
*
Author for correspondence: Jai L. Shah, E-mail: jai.shah@mcgill.ca
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Rapid progression from the first identifiable symptom to the onset of first-episode psychosis (FEP) allows less time for early intervention. The aim of this study was to examine the association between the first identifiable symptom and the subsequent speed of illness progression.

Methods

Data were available for 390 patients attending a catchment-based early intervention service for FEP. Exposure to non-psychotic and subthreshold psychotic symptoms was retrospectively recorded using semi-structured interviews. Outcomes following the onset of the first identifiable symptom were (1) time to onset of FEP and (2) symptom incidence rate (i.e. number of symptoms emerging per person-year until FEP onset). These outcomes were respectively analyzed with Cox proportional hazards and negative binomial regressions.

Results

After Bonferroni correction, having a subthreshold psychotic (v. non-psychotic) symptom as the first symptom was not associated with time to FEP onset [hazard ratio (HR) = 1.39; 95% CI 0.94–2.04] but was associated with higher symptom incidence [incidence rate ratio (IRR) = 1.92; 95% CI 1.10–3.48]. A first symptom of suspiciousness was associated with shorter time to FEP onset (HR = 2.37; 95% CI 1.38–4.08) and higher symptom incidence rate (IRR = 3.20; 95% CI 1.55–7.28) compared to other first symptoms. In contrast, a first symptom of self-harm was associated with lower symptom incidence rate (IRR = 0.06; 95% CI 0.01–0.73) compared to other first symptoms. Several associations between symptoms and illness progression were moderated by the age at symptom onset.

Conclusions

Appreciating the content and timing of early symptoms can identify windows and treatment targets for early interventions in psychosis.

Keywords

Early interventionprodromepsychotic experiencesself-harmsuspiciousness
Type
Original Article
Information
Psychological Medicine , Volume 53 , Issue 5 , April 2023 , pp. 2008 - 2016
Check for updates
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Barton, J., Kyle, S. D., Varese, F., Jones, S. H., & Haddock, G. (2018). Are sleep disturbances causally linked to the presence and severity of psychotic-like, dissociative and hypomanic experiences in non-clinical populations? A systematic review. Neuroscience & Biobehavioral Reviews, 89, 119–131.CrossRefGoogle Scholar
Bolhuis, K., Lång, U., Gyllenberg, D., Kääriälä, A., Veijola, J., Gissler, M., … Kelleher, I. (2021). Hospital presentation for self-harm in youth as a risk marker for later psychotic and bipolar disorders: A cohort study of 59 476 Finns. Schizophrenia Bulletin, sbab061, 1–10.Google Scholar
Carpenter, J. S., Crouse, J. J., Scott, E. M., Naismith, S. L., Wilson, C., Scott, J., … Hickie, I. B. (2021). Circadian depression: A mood disorder phenotype. Neuroscience and Biobehavioral Reviews, 126, 79–101.CrossRefGoogle ScholarPubMed
Clarke, M., Whitty, P., Browne, S., McTigue, O., Kamali, M., Gervin, M., … O'Callaghan, E. (2006). Untreated illness and outcome of psychosis. Cambridge University Press The British Journal of Psychiatry, 189, 235–240.CrossRefGoogle ScholarPubMed
Crouse, J. J., Ho, N., Scott, J., Martin, N. G., Couvy-Duchesne, B., Hermens, D. F., … Hickie, I. B. (2021). Days out of role and somatic, anxious-depressive, hypo-manic, and psychotic-like symptom dimensions in a community sample of young adults. Translational Psychiatry, 11, 285.CrossRefGoogle Scholar
Cupo, L., McIlwaine, S. V., Daneault, J.-G., Malla, A. K., Iyer, S. N., Joober, R., … Shah, J. L. (2021). Timing, distribution, and relationship between nonpsychotic and subthreshold psychotic symptoms prior to emergence of a first episode of psychosis. Schizophrenia Bulletin, 47(3), 604–614.CrossRefGoogle ScholarPubMed
de Jong, A., Giel, R., Lindeboom, E. G., Slooff, C. J., & Wiersma, D. (1984). Foulds’ hierarchical model of psychiatric illness in a Dutch cohort: A re-evaluation. Psychological Medicine, 14, 647–654.CrossRefGoogle Scholar
De Loore, E., Gunther, N., Drukker, M., Feron, F., Sabbe, B., Deboutte, D., … Myin-Germeys, I. (2011). Persistence and outcome of auditory hallucinations in adolescence: A longitudinal general population study of 1800 individuals. Schizophrenia Research, 127, 252–256.CrossRefGoogle ScholarPubMed
Docherty, J. P., Van Kammen, D. P., Siris, S. G., & Marder, S. R. (1978). Stages of onset of schizophrenic psychosis. US: American Psychiatric Assn The American Journal of Psychiatry, 135, 420–426.Google ScholarPubMed
Efron, B. (1977). The efficiency of Cox's likelihood function for censored data. Journal of the American Statistical Association, 72, 557–565.CrossRefGoogle Scholar
First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. (2002). Structured clinical interview for DSM-IV-TR axis I disorders: Research version, patient edition. New York, NY: Biometrics Research.Google Scholar
Fisher, H. L., Craig, T. K., Fearon, P., Morgan, K., Dazzan, P., Lappin, J., … Morgan, C. (2011). Reliability and comparability of psychosis patients’ retrospective reports of childhood abuse. Schizophrenia Bulletin, 37, 546–553.CrossRefGoogle ScholarPubMed
Freeman, D., Sheaves, B., Goodwin, G. M., Yu, L.-M., Nickless, A., Harrison, P. J., … Espie, C. A. (2017). The effects of improving sleep on mental health (OASIS): A randomised controlled trial with mediation analysis. The Lancet. Psychiatry, 4, 749–758.CrossRefGoogle ScholarPubMed
Fusar-Poli, P., Salazar de Pablo, G., Correll, C. U., Meyer-Lindenberg, A., Millan, M. J., Borgwardt, S., … Arango, C. (2020). Prevention of psychosis: Advances in detection, prognosis, and intervention. JAMA Psychiatry, 77, 755.CrossRefGoogle ScholarPubMed
Gayer-Anderson, C., Reininghaus, U., Paetzold, I., Hubbard, K., Beards, S., Mondelli, V., … Morgan, C. (2020). A comparison between self-report and interviewer-rated retrospective reports of childhood abuse among individuals with first-episode psychosis and population-based controls. Journal of Psychiatric Research, 123, 145–150.CrossRefGoogle ScholarPubMed
Guloksuz, S., Pries, L.-K., ten Have, M., de Graaf, R., van Dorsselaer, S., Klingenberg, B., … van Os, J. (2020). Association of preceding psychosis risk states and non-psychotic mental disorders with incidence of clinical psychosis in the general population: A prospective study in the NEMESIS-2 cohort. World Psychiatry, 19, 199–205.CrossRefGoogle ScholarPubMed
Hambrecht, M., Häfner, H., & Löffler, W. (1994). Beginning schizophrenia observed by significant others. Social Psychiatry and Psychiatric Epidemiology, 29, 53–60.CrossRefGoogle ScholarPubMed
Harris, M. G., Henry, L. P., Harrigan, S. M., Purcell, R., Schwartz, O. S., Farrelly, S. E., … McGorry, P. D. (2005). The relationship between duration of untreated psychosis and outcome: An eight-year prospective study. Schizophrenia Research, 79, 85–93.CrossRefGoogle ScholarPubMed
Healy, C., Coughlan, H., Clarke, M., Kelleher, I., & Cannon, M. (2020). What mediates the longitudinal relationship between psychotic experiences and psychopathology? Journal of Abnormal Psychology, 129, 505–516.CrossRefGoogle ScholarPubMed
Hollingshead, A. B. (1975). Four factor index of social status. New Haven, CT: unpublished manuscript.Google Scholar
Jones, A. A., Gicas, K. M., Mostafavi, S., Woodward, M. L., Leonova, O., Vila-Rodriguez, F., … Honer, W. G. (2021a). Dynamic networks of psychotic symptoms in adults living in precarious housing or homelessness. Psychological Medicine, FirstView, 1–11.Google Scholar
Kassambara, A., Kosinski, M., Biecek, P., & Fabian, S. (2021). survminer: Drawing survival curves using ‘ggplot2’. CRAN: R-Packages.Google Scholar
Keshavan, M. S., Giedd, J., Lau, J. Y. F., Lewis, D. A., & Paus, T. (2014). Changes in the adolescent brain and the pathophysiology of psychotic disorders. The Lancet Psychiatry, 1, 549–558.CrossRefGoogle ScholarPubMed
Koutsouleris, N., Dwyer, D. B., Degenhardt, F., Maj, C., Urquijo-Castro, M. F., Sanfelici, R., … PRONIA Consortium (2021). Multimodal machine learning workflows for prediction of psychosis in patients with clinical high-risk syndromes and recent-onset depression. JAMA Psychiatry 78, 195.CrossRefGoogle ScholarPubMed
Lenth, R. (2020). emmeans: Estimated marginal means, Aka least-squares Means. CRAN: R-Packages.Google Scholar
Lindgren, M., Kuvaja, H., Jokela, M., & Therman, S. (2021). Predictive validity of psychosis risk models when applied to adolescent psychiatric patients. Psychological Medicine, FirstView, 1–12.CrossRefGoogle Scholar
McGorry, P. D., Hartmann, J. A., Spooner, R., & Nelson, B. (2018). Beyond the ‘at risk mental state’ concept: Transitioning to transdiagnostic psychiatry. World Psychiatry, 17, 133–142.CrossRefGoogle ScholarPubMed
Messias, E., Kirkpatrick, B., Ram, R., & Tien, A. Y. (2001). Suspiciousness as a specific risk factor for major depressive episodes in schizophrenia. Schizophrenia Research, 47, 159–165.CrossRefGoogle ScholarPubMed
Nadig, A., Seidlitz, J., McDermott, C. L., Liu, S., Bethlehem, R., Moore, T. M., … Raznahan, A. (2021). Morphological integration of the human brain across adolescence and adulthood. Proceedings of the National Academy of Sciences, 118, e2023860118.CrossRefGoogle ScholarPubMed
Norman, R. M. G., & Malla, A. K. (2002). Prevention and early intervention for psychosis program (PEPP): Course of onset and relapse schedule: Interview and coding instruction guide. London, Ontario, Canada: London Health Sciences Centre.Google Scholar
Ohayon, M. M. (2000). Prevalence of hallucinations and their pathological associations in the general population. Psychiatry Research, 97, 153–164.CrossRefGoogle ScholarPubMed
Paquin, V., Lapierre, M., Veru, F., & King, S. (2021). Early environmental upheaval and the risk for schizophrenia. Annual Review of Clinical Psychology, 17, 285–311.CrossRefGoogle ScholarPubMed
Pedersen, E. M., Agerbo, E., Plana-Ripoll, O., Grove, J., Dreier, J. W., Musliner, K. L., … Vilhjálmsson, B. J. (2021). Accounting for age-of-onset and family history improves power in genome-wide association studies. bioRxiv, 2021.04.20.440585, 1–31.Google Scholar
Petanjek, Z., Judaš, M., Šimić, G., Rašin, M. R., Uylings, H. B. M., Rakic, P., & Kostović, I. (2011). Extraordinary neoteny of synaptic spines in the human prefrontal cortex. Proceedings of the National Academy of Sciences, 108, 13281–13286.CrossRefGoogle ScholarPubMed
Rosen, M., Betz, L. T., Schultze-Lutter, F., Chisholm, K., Haidl, T. K., Kambeitz-Ilankovic, L., … Kambeitz, J. (2021). Towards clinical application of prediction models for transition to psychosis: A systematic review and external validation study in the PRONIA sample. Neuroscience & Biobehavioral Reviews, 125, 478–492.CrossRefGoogle ScholarPubMed
Rosengard, R. J., Makowski, C., Chakravarty, M., Malla, A. K., Joober, R., Shah, J. L., & Lepage, M. (2020). Pre-onset sub-threshold psychotic symptoms and cortical organization in the first episode of psychosis. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 100, 109879.CrossRefGoogle ScholarPubMed
Rosengard, R. J., Malla, A., Mustafa, S., Iyer, S. N., Joober, R., Bodnar, M., … Shah, J. L. (2019). Association of pre-onset subthreshold psychotic symptoms with longitudinal outcomes during treatment of a first episode of psychosis. JAMA Psychiatry, 76, 61.CrossRefGoogle ScholarPubMed
Ruhrmann, S., Schultze-Lutter, F., Salokangas, R. K. R., Heinimaa, M., Linszen, D., Dingemans, P., … Klosterkötter, J. (2010). Prediction of psychosis in adolescents and young adults at high risk: Results from the prospective European prediction of psychosis study. Archives of General Psychiatry, 67, 241.CrossRefGoogle Scholar
Schultze-Lutter, F., Rahman, J., Ruhrmann, S., Michel, C., Schimmelmann, B. G., Maier, W., & Klosterkötter, J. (2015). Duration of unspecific prodromal and clinical high risk states, and early help-seeking in first-admission psychosis patients. Social Psychiatry and Psychiatric Epidemiology, 50, 1831–1841.CrossRefGoogle ScholarPubMed
Shah, J. L., Crawford, A., Mustafa, S. S., Iyer, S. N., Joober, R., & Malla, A. K. (2017). Is the clinical high-risk state a valid concept? Retrospective examination in a first-episode psychosis sample. Psychiatric Services, 68, 1046–1052.CrossRefGoogle Scholar
Shah, J. L., Scott, J., McGorry, P. D., Cross, S. P. M., Keshavan, M. S., Nelson, B. … International Working Group on Transdiagnostic Clinical Staging in Youth Mental Health (2020). Transdiagnostic clinical staging in youth mental health: A first international consensus statement. World Psychiatry, 19, 233–242.CrossRefGoogle ScholarPubMed
Shakoor, S., McGuire, P., Cardno, A. G., Freeman, D., Plomin, R., & Ronald, A. (2015). A shared genetic propensity underlies experiences of bullying victimization in late childhood and self-rated paranoid thinking in adolescence. Schizophrenia Bulletin, 41, 754–763.CrossRefGoogle ScholarPubMed
Solmi, M., Radua, J., Olivola, M., Croce, E., Soardo, L., Salazar de Pablo, G., … Fusar-Poli, P. (2021b). Age at onset of mental disorders worldwide: Large-scale meta-analysis of epidemiological studies. Molecular Psychiatry, in press, 1–15.Google Scholar
Vandenbroucke, J. P., von Elm, E., Altman, D. G., Gøtzsche, P. C., Mulrow, C. D., Pocock, S. J., … Egger, M. (2007). Strengthening the reporting of observational studies in epidemiology (STROBE): Explanation and elaboration. Annals of Internal Medicine, 147, W-163.CrossRefGoogle ScholarPubMed
van Os, J., Schaub, A., Carpenter, W. T. (2021). Resurrection of the follow-back method to study the transdiagnostic origins of psychosis: Comment on: ‘Timing, distribution, and relationship between nonpsychotic and subthreshold psychotic symptoms prior to emergence of a first episode of psychosis’, by Cupo et al. Schizophrenia Bulletin, 47, 583–585.CrossRefGoogle Scholar
Winton-Brown, T. T., & Kapur, S. (2020). Aberrant salience attribution and psychosis. In Tamminga, C., van Os, J., Reininghaus, U. and Ivleva, E. (Eds.), Psychotic Disorders: Comprehensive Conceptualization and Treatments (pp. 442–450). Oxford, UK: Oxford University Press.Google Scholar
Wong, K. K., Freeman, D., & Hughes, C. (2014). Suspicious young minds: Paranoia and mistrust in 8- to 14-year-olds in the UK and Hong Kong. The British Journal of Psychiatry, 205, 221–229.CrossRefGoogle ScholarPubMed
Yung, A. R., & McGorry, P. D. (1996). The prodromal phase of first-episode psychosis: Past and current conceptualizations. Schizophrenia Bulletin, 22, 353–370.CrossRefGoogle ScholarPubMed
Yung, A. R., Yung, A. R., Pan Yuen, H., Mcgorry, P. D., Phillips, L. J., Kelly, D., … Buckby, J. (2005). Mapping the onset of psychosis: The comprehensive assessment of at-risk mental states. Australian & New Zealand Journal of Psychiatry, 39, 964–971.CrossRefGoogle ScholarPubMed
Supplementary material: File

Paquin et al. supplementary material

Tables S1-S3 and Figures S1-S7

Download Paquin et al. supplementary material(File)
File 1.3 MB