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Developmental perspectives on the origins of psychotic disorders: The need for a transdiagnostic approach
- Elaine F. Walker, Katrina Aberizk, Emerald Yuan, Zarina Bilgrami, Benson S. Ku, Ryan M. Guest
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- Journal:
- Development and Psychopathology , First View
- Published online by Cambridge University Press:
- 26 February 2024, pp. 1-11
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Research on serious mental disorders, particularly psychosis, has revealed highly variable symptom profiles and developmental trajectories prior to illness-onset. As Dante Cicchetti pointed out decades before the term “transdiagnostic” was widely used, the pathways to psychopathology emerge in a system involving equifinality and multifinality. Like most other psychological disorders, psychosis is associated with multiple domains of risk factors, both genetic and environmental, and there are many transdiagnostic developmental pathways that can lead to psychotic syndromes. In this article, we discuss our current understanding of heterogeneity in the etiology of psychosis and its implications for approaches to conceptualizing etiology and research. We highlight the need for examining risk factors at multiple levels and to increase the emphasis on transdiagnostic developmental trajectories as a key variable associated with etiologic subtypes. This will be increasingly feasible now that large, longitudinal datasets are becoming available and researchers have access to more sophisticated analytic tools, such as machine learning, which can identify more homogenous subtypes with the ultimate goal of enhancing options for treatment and preventive intervention.
73 Identification of 24-Month Cognitive Trajectories Among Clinical High Risk for Psychosis (CHR-P) Using Latent Class Mixture Modeling
- Ryan M. Guest, Jean Addington, Carrie E. Bearden, Kristin S. Cadenhead, Barbara A. Cornblatt, Daniel H. Mathalon, Diana O. Perkins, Ming T. Tsuang, Scott W. Woods, Tyrone D. Cannon, Matcheri S. Keshavan, William S. Stone, Elaine F. Walker
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 857-858
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Objective:
Cohort studies demonstrate that people who later develop schizophrenia, on average, present with mild cognitive deficits in childhood and endure a decline in adolescence and adulthood. Yet, tremendous heterogeneity exists during the course of psychotic disorders, including the prodromal period. Individuals identified to be in this period (known as CHR-P) are at heightened risk for developing psychosis (~35%) and begin to exhibit cognitive deficits. Cognitive impairments in CHR-P (as a singular group) appear to be relatively stable or ameliorate over time. A sizeable proportion has been described to decline on measures related to processing speed or verbal learning. The purpose of this analysis is to use data-driven approaches to identify latent subgroups among CHR-P based on cognitive trajectories. This will yield a clearer understanding of the timing and presentation of both general and domain-specific deficits.
Participants and Methods:Participants included 684 young people at CHR-P (ages 12–35) from the second cohort of the North American Prodromal Longitudinal Study. Performance on the MATRICS Consensus Cognitive Battery (MCCB) and the Wechsler Abbreviated Scale of Intelligence (WASI-I) was assessed at baseline, 12-, and 24-months. Tested MCCB domains include verbal learning, speed of processing, working memory, and reasoning & problem-solving. Sex- and age-based norms were utilized. The Oral Reading subtest on the Wide Range Achievement Test (WRAT4) indexed pre-morbid IQ at baseline. Latent class mixture models were used to identify distinct trajectories of cognitive performance across two years. One- to 5-class solutions were compared to decide the best solution. This determination depended on goodness-of-fit metrics, interpretability of latent trajectories, and proportion of subgroup membership (>5%).
Results:A one-class solution was found for WASI-I Full-Scale IQ, as people at CHR-P predominantly demonstrated an average IQ that increased gradually over time. For individual domains, one-class solutions also best fit the trajectories for speed of processing, verbal learning, and working memory domains. Two distinct subgroups were identified on one of the executive functioning domains, reasoning and problem-solving (NAB Mazes). The sample divided into unimpaired performance with mild improvement over time (Class I, 74%) and persistent performance two standard deviations below average (Class II, 26%). Between these classes, no significant differences were found for biological sex, age, years of education, or likelihood of conversion to psychosis (OR = 1.68, 95% CI 0.86 to 3.14). Individuals assigned to Class II did demonstrate a lower WASI-I IQ at baseline (96.3 vs. 106.3) and a lower premorbid IQ (100.8 vs. 106.2).
Conclusions:Youth at CHR-P demonstrate relatively homogeneous trajectories across time in terms of general cognition and most individual domains. In contrast, two distinct subgroups were observed with higher cognitive skills involving planning and foresight, and they notably exist independent of conversion outcome. Overall, these findings replicate and extend results from a recently published latent class analysis that examined 12-month trajectories among CHR-P using a different cognitive battery (Allott et al., 2022). Findings inform which individuals at CHR-P may be most likely to benefit from cognitive remediation and can inform about the substrates of deficits by establishing meaningful subtypes.
Contributors
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- By Dag Aarsland, Adrià Arboix, Carlos Bazán, James T. Becker, Sylvie Belleville, Kevin M. Biglan, Sandra E. Black, Mariana Blanco, Rémi W. Bouchard, Bruce J. Brew, David J. Burn, Leonardo Caixeta, Richard Camicioli, Paulo Caramelli, Neil Cashman, Nicholas W. S. Davies, Yan Deschaintre, Rachel S. Doody, Bruno Dubois, Uwe Ehrt, Stephane Epelbaum, Ryan V. V. Evans, Joseph M. Ferrara, Bruno Franchi, Morris Freedman, Anders Gade, Serge Gauthier, Marta Grau-Olivares, Matthew E. Growdon, Will Guest, Marie Christie Guiot, Shahul Hameed, Mirna Lie Hosogi-Senaha, Ging-Yuek Robin Hsiung, Masamichi Ikawa, Rajive Jassal, Vesna Jelic, Peter Johannsen, Edward S. Johnson, Mary M. Kenan, Bert-Jan Kerklaan, Benjamin Lam, Gabriel C. Léger, Gabriel Leonard, Emilie Lepage, Irene Litvan, Oscar L. Lopez, Ian R. A. Mackenzie, Mario Masellis, Fodi Massoud, Paige Moorhouse, John C. Morris, Taim Muayqil, Yannick Nadeau, Inger Nennesmo, Jørgen E. Nielsen, Ricardo Nitrini, Sven-Eric Pålhagen, Robert Perry, Gerald Pfeffer, Machiel Pleizier, Steffen Plickert, Gil D. Rabinovici, Philippe H. Robert, Lothar Resch, Gustavo C. Román, Maxime Ros, Pedro Rosa-Neto, Aiman Sanosi, Philip Scheltens, Christian Schmidt, Eric Schmidt, Jean-Paul Soucy, Jette Stokholm, David Summers, Rawan Tarawneh, Louis Verret, Huali Wang, Bengt Winblad, Makoto Yoneda, Xin Yu, Inga Zerr
- Edited by Serge Gauthier, McGill University, Montréal, Pedro Rosa-Neto, McGill University, Montréal
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- Book:
- Case Studies in Dementia
- Published online:
- 16 May 2011
- Print publication:
- 21 April 2011, pp viii-xiv
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