Commentary about social avoidance and its significance in adolescents and young adults.

Social avoidance in young patients is a clinically worrisome phenomenon that characterizes impending schizophrenia, but that also constitutes a core phenomenon in avoidant personality disorder (AvPD), schizoid personality disorder (ScPD), and in autism spectrum disorder (ASD). Especially in the absence of any other clinically relevant phenomena, understanding the origins of social avoidance may be one the most challenging tasks in assessing whether adolescents and young adults are at risk for developing schizophrenia. Descriptive and psychometric assessments only allow to comment on the absence or the presence of this phenomenon, but do not capture the origins and the meaning of social avoidance.

Clinical and functional ultra-long-term outcome of patients with a clinical high risk (CHR) for psychosis.

Background: Few studies have followed up patients with a clinical high risk (CHR) for psychosis for more than 2-3 years. We aimed to investigate the rates and baseline predictors for remission from CHR and transition to psychosis over a follow-up period of up to 16 years. Additionally, we examined the clinical and functional long-term outcome of CHR patients who did not transition.

Impact on the Onset of Psychosis of a Polygenic Schizophrenia-Related Risk Score and Changes in White Matter Volume.

Background: Reductions in the volume of brain white matter are a common feature in schizophrenia and bipolar disorder while the association between white matter and polygenic schizophrenia-related risk is unclear. To look at the intermediate state between health and the full-blown disorder, we investigated this aspect in groups of patients before and after the onset of psychosis.

Methods: On a 3 Tesla scanner, total and regional white matter volumes were investigated by structural magnetic resonance imaging (MRI) in the following groups: 37 at-risk mental state patients (ARMS), including 30 with no transition to psychosis (ARMS-NT) and 7 with a transition to psychosis (ARMS-T) pooled with 25 first episode psychosis (FEP) patients.

Alterations in the hippocampus and thalamus in individuals at high risk for psychosis.

Reduction in hippocampal volume is a hallmark of schizophrenia and already present in the clinical high-risk state. Nevertheless, other subcortical structures, such as the thalamus, amygdala and pallidum can differentiate schizophrenia patients from controls. We studied the role of hippocampal and subcortical structures in clinical high-risk individuals from two cohorts.

Heterogeneity of Psychosis Risk Within Individuals at Clinical High Risk: A Meta-analytical Stratification.

Importance: Individuals can be classified as being at clinical high risk (CHR) for psychosis if they meet at least one of the ultra-high-risk (UHR) inclusion criteria (brief limited intermittent psychotic symptoms [BLIPS] and/or attenuated psychotic symptoms [APS] and/or genetic risk and deterioration syndrome [GRD]) and/or basic symptoms [BS]. The meta-analytical risk of psychosis of these different subgroups is still unknown.

Objective: To compare the risk of psychosis in CHR individuals who met at least one of the major inclusion criteria and in individuals not at CHR for psychosis (CHR-).

Declining transition rates to psychosis: the role of diagnostic spectra and symptom overlaps in individuals with attenuated psychosis syndrome.

Transition to psychosis in at-risk individuals has markedly declined in recent years. So far it has never been discussed in detail that with the growing awareness and increasing availability of early psychosis services, a much broader diagnostic spectrum is now being seen in these services. Subsequently, subjects present with symptoms that meet psychosis risk on a purely psychometric basis but may be the phenotypical expression of another underlying mental disorder.

Cenesthopathy in adolescence: an appraisal of diagnostic overlaps along the anxiety-hypochondriasis-psychosis spectrum.

Objective: To discuss the diagnostic validity of unusual bodily perceptions along the spectrum from age-specific, often transitory and normal, to pathological phenomena in adolescence to hypochondriasis and finally to psychosis.

Methods: Critical literature review of the cornerstone diagnostic groups along the spectrum embracing anxiety and cenesthopathy in adolescence, hypochondriasis, and cenesthopathy and psychosis, followed by a discussion of the diagnostic overlaps along this spectrum.

Results: The review highlights significant overlaps between the diagnostic cornerstones.

Moving beyond transition outcomes: meta-analysis of remission rates in individuals at high clinical risk for psychosis.

Recent evidence suggests that transition risks from initial clinical high risk (CHR) status to psychosis are decreasing. The role played by remission in this context is mostly unknown. The present study addresses this issue by means of a meta-analysis including eight relevant studies published up to January 2012 that reported remission rates from an initial CHR status.

Cognitive functioning in at-risk mental states for psychosis and 2-year clinical outcome.

Background: Cognitive impairment is prevalent in at-risk mental states (ARMS) for psychosis.

Method: We studied cognitive functioning at baseline in ARMS individuals and investigated its power to predict ARMS persistence and remission at 2-year follow-up.

Results: 196 patients were recruited.

Cannabis-induced depersonalization disorder in adolescence.

We present a case series of 6 patients who developed persistent depersonalization disorder in adolescence after consuming cannabis. In 2 of these cases, the illness course was severely disabling. Within the growing body of literature that investigates the effects of cannabis use on mental health, the association between cannabis and depersonalization disorder is widely neglected.

The Swiss Early Psychosis Project SWEPP: a national network.

Aim: The study aims to describe the activities of the Swiss Early Psychosis Project (SWEPP) which was founded in 1999 as a national network to further and disseminate knowledge on early psychosis (EP) and to enhance collaboration between healthcare groups.

Methods: The present paper is a detailed account of the initiation and the development of the Swiss network. We describe all activities such as the several educational campaigns that were addressed to primary and secondary care groups since the early days.

Ultra high-risk state for psychosis and non-transition: a systematic review.

Background: Most effort in ultra high-risk (UHR) research has been directed at defining the clinical and neurobiological characteristics of those UHR subjects who go on to develop psychosis. The characteristics and outcome of the remaining UHR subjects have remained relatively unexplored.

Method: We performed a systematic review of clinical UHR studies to investigate whether information was available on the characteristics and outcome of UHR subjects who did not convert to psychosis.

Primary care and the early phases of schizophrenia in the Czech Republic.

Aim: To explore knowledge, treatment setting, attitudes and needs associated with patients in early phases of psychosis among general practitioners (GPs) in Prague, and to compare results with GPs from 6 countries participating in the International GP Study (IGPS) on Early Psychosis (Canada, Australia, New Zealand, England, Norway, Austria).

Methods: Survey questionnaires were mailed to 648 GPs in the city of Prague.

Results: The response rate was 19.

Prodromal schizophrenia in primary care: a randomised sensitisation study.

Background: GPs are often the first point of contact for patients with prodromal schizophrenia. Early intervention, and therefore early detection, of schizophrenia is pivotal for the further disease course. However, recent studies have revealed that, due to its low prevalence in general practice and its insidious features, prodromal schizophrenia often remains unnoticed.

Learned irrelevance and associative learning is attenuated in individuals at risk for psychosis but not in asymptomatic first-degree relatives of schizophrenia patients: translational state markers of psychosis?

Learned irrelevance (LIrr) refers to a form of selective learning that develops as a result of prior noncorrelated exposures of the predicted and predictor stimuli. In learning situations that depend on the associative link between the predicted and predictor stimuli, LIrr is expressed as a retardation of learning. It represents a form of modulation of learning by selective attention.

High remission rates from an initial ultra-high risk state for psychosis.

Objective: To investigate the proportion of patients among subjects initially identified as fulfilling the ultra-high risk (UHR) criteria for psychosis using the Scale of Prodromal Symptoms (SOPS) who fully remitted after one year.

Method: Seventy-two patients between 14 and 40 years who were referred to the Bruderholz Early Psychosis Outpatient Service in Switzerland and who met UHR criteria were included in the present study. At 1-year follow-up, data for 52 patients were available.

Subclinical hallucinations in adolescent outpatients: an outcome study.

Objective: We assessed the continued prevalence at one year and association with clinical variables of subclinical hallucinations ascertained at baseline in a cohort of adolescent outpatients referred to a specialized early psychosis service. We further assessed the prevalence of psychiatric disorders in adolescents presenting subclinical hallucinations.

Method: 84 adolescent patients were sampled from a longitudinal, prospective study that assesses the course of clinical and neuropsychological measures in patients identified as at high clinical risk for psychosis.

The International Study on General Practitioners and Early Psychosis (IGPS).

Background: In much of the world, general practitioners (GPs) are the health professionals most frequently initially contacted when a young person is developing psychosis. However little is known about their expertise in assessing psychosis and its risk.

Methods: To assess the diagnostic patterns and treatment practices related to psychosis of GPs working in a range of health care systems, questionnaires were mailed to 12,516 randomly selected GPs in seven countries: Canada, Australia, New Zealand, England, Norway, Austria and the Czech Republic.

Deficient associative learning in drug-naive first-episode schizophrenia: results obtained using a new visual within-subjects learned irrelevance paradigm.

One of the key features of schizophrenia is the inability to filter out irrelevant stimuli which consequently leads to stimulus overload. There are different methods which aim at investigating these deficient filter mechanisms; one of these is the learned irrelevance (LIrr) paradigm. LIrr refers to the retardation of associative learning that occurs if the conditioned stimulus (CS) and the unconditioned stimulus (US) are preexposed in an explicitly unpaired manner prior to the establishment of the association between the stimuli.

[On the front line: survey on shared responsibility. General practitioners and schizophrenia].

Context: General practitioners (GP) play a preponderant role in the treatment of patients suffering of schizophrenia.

Objectives: Discovering the number of patients with schizophrenia who are treated by GPs ; the needs and attitudes of GPs, their knowledge concerning diagnosis, and the treatment they provide.

Methodology: A postal survey was conducted with Quebec GPs who were randomly chosen.

Cognitive functioning in the schizophrenia prodrome.

In the last decade, there has been an increasing interest in cognitive alterations during the early course of schizophrenia. From a clinical perspective, a better understanding of cognitive functioning in putative at-risk states for schizophrenia is essential for developing optimal early intervention models. Two approaches have more recently been combined to assess the entire course of the initial schizophrenia prodrome: the predictive "basic symptom at-risk" (BS) and the ultra high-risk (UHR) criteria.

Insight, symptoms and executive functions in schizophrenia.

Introduction: We investigated the relationship of insight with executive functions and symptoms in a group of stabilised inpatients with schizophrenia.

Methods: Executive functions using an extensive battery constituted of several tests as well as psychopathology were assessed in 38 inpatients with a DSM-IV diagnosis of schizophrenia. Insight was assessed with the Scale to assess Unawareness of Mental Disorder (SUMD).