Translation and cross-cultural adaptation to Brazilian Portuguese of two brief screening tools for youth at risk of psychosis: the Prodromal Questionnaire (PQ-16) and the PRIME-Screen

Abstract Introduction Prodromal characteristics of psychosis have been described for more than a century. Over the last three decades, a variety of studies have proposed methods to prospectively identify individuals (and youth in particular) who are at high risk of developing a psychotic disorder. These studies have validated various screening instruments and made them available in several languages. Here, we describe the translation into Brazilian Portuguese and cross-cultural adaptation of two such screening tools - the Prodromal Questionnaire-16 (PQ-16) and the Prevention through Risk Identification, Management, and Education (PRIME)-Screen. Method Two bilingual native speakers of Brazilian Portuguese translated the questionnaires from English. A native English speaker then performed back-translations into English. These back-translated versions were submitted to the original authors. They provided feedback and later approved the final versions. Results After translation and cross-cultural adaptation, no items needed to be changed in the adapted PQ-16 and four items were revised in the PRIME-Screen. After the peer-review process, we included two suggestions in the PQ-16 to facilitate use of the tool in our cultural and social contexts. The PRIME-Screen did not need further changes. Conclusion These new instruments can help screen Brazilian Portuguese-speaking patients who are at risk of psychosis in primary care.

Terapia cognitivo conductual para pacientes con riesgo clínico de psicosis / Cognitive behavior therapy for young patients at clinical risk for psychosis

INTRODUCCIÓN. Los estudios de tratamiento indican que el riesgo de transición a un trastorno psicótico puede al menos retrasarse en la población clínica de alto riesgo de psicosis (CHR), además de mejorar variables relacionadas con la calidad de vida de los pacientes, existiendo evidencia a favor de la terapia cognitivo conductual (TCC). MÉTODOS. Se realizó una síntesis narrativa, basada en la búsqueda de artículos originales, que abordasen la efectividad de la TCC en pacientes CHR, publicados en los últimos cinco años, incluidos en esta síntesis. RESULTADOS. Se incluyeron un total de 10 artículos que evalúan la TCC en CHR, siendo un tratamiento efectivo y ampliamente utilizado, lo que se asocia a una disminución en las consecuencias psicosociales que conlleva el retraso en la presentación del cuadro clínico y/o la disminución de síntomas comórbidos. CONCLUSIÓN. Actualmente, la TCC se ha convertido en el tratamiento de primera elección para CHR, existiendo una gran variedad de estrategias psicoterapéuticas específicas dentro de este grupo de intervención.

INTRODUCTION. Treatment studies indicate that the risk of transition to a psychotic disorder can at least be delayed in the clinical population at high risk for psychosis (CHR), in addition to improving variables related to the quality of life of patients, with evidence in favor of cognitive behavioral therapy (CBT). METHODS. A narrative synthesis was carried out, based on the search for original articles, which addressed the effectiveness of CBT in CHR patients, published in the last five years, included in this synthesis. RESULTS. A total of 10 articles that evaluate CBT in CHR were included, being an effective and widely used treatment, which is associated with a decrease in the psychosocial consequences that the delay in the presentation of the clinical picture and/or the decrease in symptoms entails. comorbid. CONCLUSION. Currently, CBT has become the treatment of first choice for CHR, with a wide variety of specific psychotherapeutic strategies within this intervention group.

Changes of microstructure of white matter and clinical high risk for psychosis / 中华行为医学与脑科学杂志

The research on clinical high-risk for psychosis is a hotspot in recent years, which is helpful to the early identification and early intervention of psychosis. White matter fibers are the important structural basis of complex information transmission function among brain regions. The existing literatures show that there are abnormal white matter microstructures in individuals at clinical high-risk for psychosis, which is related to their clinical symptoms and social function. Diffusion tensor imaging is the only non-invasive technique to study the microstructure of brain white matter. This paper reviews the existing evidences of microstructural abnormalities of white matter at clinical high-risk for psychosis by diffusion tensor imaging, in order to comprehensively analyze the potential neurobiomarkers in the early stage of the disease and the pathological evolution characteristics in the development of the disease.

Análisis de alteraciones del discurso en estados mentales de alto riesgo de psicosis (EMAR): una revisión sistemática / Speech disturbances analysis in ultra-high risk of psychosis (UHR): a systematic review

INTRODUCCIÓN: La necesidad de intervenir precozmente en la psicosis ha llevado a la búsqueda de biomarcadores útiles en su predicción, donde el análisis del lenguaje hablado destaca por su fácil obtención y bajo coste económico. En esta revisión sistemática se analizan las principales alteraciones del lenguaje en pacientes con riesgo ultra alto de psicosis (UHR), evaluando su prevalencia y su relación con la transición a la psicosis. MÉTODOS: Se realizó una búsqueda en las bases de datos PubMed y Embase de estudios en inglés o español, así como en las listas de referencias de los artículos encontrados. RESULTADOS: De 140 artículos identificados, se incluyeron 15. Las variables del lenguaje analizadas fueron Cohesión Lingüística, Coherencia Semántica, Complejidad Sintáctica, Producción Metafórica, Prosodia Emocional y Trastorno del Pensamiento Formal (TFP). La prevalencia encontrada osciló entre el 21% y el 85% para las alteraciones incluidas en el TFP, sin que se hayan encontrado medidas de prevalencia para el resto de las variables. La precisión global para la transición de RH a psicosis osciló entre el 70% y el 100% en todos los estudios. CONCLUSIONES: Existe un amplio abanico de alteraciones del habla en los pacientes con RHU, donde la PTF es la más estudiada. La prevalencia de estas alteraciones parece ser alta, especialmente en lo que respecta a la PTF. El análisis de esas alteraciones del habla en pacientes con RHU aparece como una excelente herramienta para predecir la transición a la psicosis, particularmente a través de la transcripción de entrevistas y el uso de la Inteligencia Artificial.

INTRODUCTION: The need for early intervention in psychosis has led to the search for useful biomarkers in its prediction, where the analysis of spoken language stands out for its easy obtaining and low economic cost. In this systematic review, we analyze the main speech disturbances in patients at ultra-high risk for psychosis (UHR), evaluating their prevalence and their relationship with transition to psychosis. METHODS: A search was carried out in PubMed and Embase databases for studies in English or Spanish, as well as the reference lists of the articles found. RESULTS: Of 140 articles identified, 15 were included. The variables of the language analyzed were Linguistic Cohesion, Semantic Coherence, Syntactic Complexity, Metaphorical Production, Emotional Prosody and Formal Thought Disorder (TFP). The prevalence found ranged between 21% and 85% for disturbances included within the TFP, with no prevalence measures for the rest of the variables. The global accuracy for UHR transition to psychosis ranged from 70% to 100% across studies. CONCLUSION: There is a wide range of speech disorders in UHR patients, where the TFP is the most studied one. The prevalence of these alterations seems to be high, especially with regard to TFP. The analysis of those speech alterations in UHR patients appears as an excellent tool to predict transition to psychosis, particularly through interview transcription and the use of Artificial Intelligence.

Comparison of the clinical response of high-risk and ultra high-risk gestational trophoblastic neoplasia to etoposide- methotrexate-actinomycin-cyclosphosphamide-vincristine: Experience at the Philippine General Hospital / Philippine Journal of Obstetrics and Gynecology

Background@#Recent studies have shown poorer outcomes for patients with prognostic score above 12. Authors have proposed categorizing these patients as ultra high-risk to emphasize the need for a different treatment regimen.@*Objectives@#This study was conducted to compare the clinical response of high-risk and ultra high-risk Gestational Trophoblastic Neoplasia (GTN) patients who were managed at the Philippine General Hospital, from January 1, 2010 to December 31, 2015, after receiving the EMACO regimen as first line treatment.@*Methods@#All patients diagnosed with metastatic high-risk GTN who were managed at the Philippine General Hospital from January 1, 2010 to December 31, 2015 and given the EMACO regimen as first-line treatment were included in the study. Patients were divided into high-risk disease or patients with a WHO prognostic score of 7-11 and ultra high-risk disease or patients with WHO prognostic score of 12 and above. Using the Z-test on two proportion, treatment outcome between the two groups were compared.@*Results@#A total of 57 patients diagnosed with metastatic high-risk GTN were included in the study. Of these, 35 or 61% were classified as high-risk while 22 or 39% were ultra high-risk. The primary remission rate of the high-risk group was 89% compared to 77% for the ultra high-risk group. The difference was not statistically significant (p=0.2542). Out of the 57 patients included in the study, 48 patients achieved remission after being treated with EMACO. An additional 4 patients achieved remission after being shifted to EPEMA due to resistance to the first line agent. All patients were alive after one year of follow-up, giving a one-year survival rate of 91.2%.@*Conclusion@#The result of this study showed a relatively higher remission rate for high-risk (89%) than ultra highrisk GTN (77%) with EMACO as first line chemotherapy regimen, but statistical analysis revealed no significant difference. This finding suggests that EMACO may still be used as first line regimen for ultra high-risk GTN to attain remission.

Fragile Self and Malevolent Others: Biased Attribution Styles in Individuals at Ultra-High Risk for Psychosis

OBJECTIVE: Biased attribution styles of assigning hostile intention to innocent others and placing the blame were found in schizophrenia. Attribution styles in individuals at ultra-high risk (UHR) for psychosis, however, have been less studied especially for its association with various psychological factors. We investigated whether UHR individuals show increased hostility perception and blaming bias and explored the associations of these biased styles of attribution with the factor structure of multifaceted self-related psychological variables and neurocognitive performances. METHODS: Fifty-four UHR individuals and 80 healthy controls were assessed by evaluating resilience, self-perception, self-esteem, and aberrant subjective experiences of schizotypy (physical anhedonia, social anhedonia, magical ideation, and perceptual aberration), basic symptoms, and carrying out a comprehensive neurocognitive test battery. Attribution styles were assessed using the Ambiguous Intentions Hostility Questionnaire. RESULTS: UHR individuals, compared with normal controls, showed increased hostility perception and blaming bias. Factor analysis of self-related psychological variables and neurocognitive performances in the entire subject population showed a three-factor solution, which was designated as reflective self, pre-reflective self, and neurocognition. Multiple regression analysis in UHR individuals revealed that hostility perception bias was associated with reflective self and composite blame bias was associated with reflective and pre-reflective self. CONCLUSION: This study supports the emergence of attribution biases in the putative ‘prodromal’ phase of schizophrenia. The associations of biased attribution styles with multifaceted self-related psychological constructs suggest that psychosocial interventions for biased attribution styles in UHR individuals should focus not only on reflective self but also pre-reflective self-related psychological constructs.

Ultra-High Risk for Psychosis : Clinical Characteristics and Diagnosis / 신경정신의학

Early detection is a crucial milestone in the prevention and treatment of schizophrenia spectrum psychosis, which might alter the course of schizophrenia. Currently, there are two complementary approaches to characterizing the clinical-high risk state of psychosis : the ultra-high risk (UHR) and basic symptoms criteria. Individuals at UHR have two phase-specific problems : heightened risk for the potential pathology of schizophrenia spectrum psychosis and the symptoms, distress and psychosocial functional impairment, which make them seek help. The clinical characteristics of UHR are similar to those of overt psychotic disorders in terms of psychopathological symptoms dimensions, psychosocial disability, neurocognitive and socio-cognitive impairments, history of trauma and abuse experience, lack of protective factors and dysfunctional metacognitive beliefs, and the comorbidity of psychiatric illness. Regarding the risk, the pretest risk probability of a psychotic disorder in each high-risk clinic is considered an important factor for predicting the power of an early detection strategy. For the distress and psychosocial disability, the strategies of the therapeutic intervention will be a focus of clinical attention. On the follow-up, one of third of the UHR individuals have sufficient positive symptom to fulfil the at-risk criteria. Most of the UHR individuals have suffered from comorbid psychiatric illness at the times of both baseline and follow-up, and there is no improvement of psychosocial functioning. Currently, it is essential to optimize the early detection and intervention strategy according to the referring and recruitment characteristics of each high-risk clinic in Korean practice situations.

Aberrant Tendency of Noncurrent Emotional Experiences in Individuals at Ultra-High Risk for Psychosis

OBJECTIVE: This study aimed to investigate whether aberrant tendency of noncurrent emotion was present in individuals at ultra-high risk (UHR) for psychosis and to explore its associations with various clinical profiles. METHODS: Fifty-seven individuals at UHR and 49 normal controls were enrolled. The tendency of experiencing noncurrent emotion was assessed using various noncurrent emotional self-reported formats, including trait [Neuroticism and Extraversion of the Eysenck Personality Questionnaire], hypothetical (Chapman’s Revised Physical and Social Anhedonia Scales), and retrospective [Anhedonia-Asociality Subscale of the Scale for the Assessment of Negative Symptoms (SANS)] measures. Self-related beliefs (Self-Perception Scale), clinical positive and negative symptoms (SA Positive Symptoms and SANS), psychosocial function (Global Functioning Scale: Role Function and Global Functioning Scale: Social Function) were also examined. RESULTS: Subjects at UHR for psychosis reported more trait unpleasant and less trait pleasant emotions, more hypothetical physical and social anhedonia, and more retrospective anhedonia than normal controls. In UHR, self-perception was correlated to trait unpleasant emotion and hypothetical physical and social anhedonia. Negative symptoms in UHR were associated with hypothetical physical anhedonia and retrospective anhedonia. Global social functioning was related to trait pleasant emotion, hypothetical physical and social anhedonia, and retrospective anhedonia. Neurocognitive function, positive symptoms, and global role functioning were not related with any noncurrent emotional experience measures in UHR. CONCLUSION: These findings suggest that the aberrant tendency of noncurrent emotional experience may be present at the ‘putative’ prodromal phase and are grossly associated with self-related beliefs and psychosocial functioning but not neurocognitive functioning.

Effect of cognitive behavior therapy on the symptoms and conversion of ultra-high-risk of schizophrenia / 中华行为医学与脑科学杂志

Objective To investigate the effect of cognitive behavior therapy (CBT) on the conversion of individuals with ultra-high-risk (UHR) of schizophrenia,and to find out the related influence factors.Methods Patients were randomly divided into study group (50 cases) and control group (49 cases) by the digital random table method.The study group received cognitive behavioral therapy,and the control group only got follow-up questionnaire.Structured Interview for Prodromal Syndromes (SIPS) was used to evaluate psychosis risk symptoms of each UHR individuals at baseline,3 months,6 months,12 months and 18 months respectively and the effects of CBT on conversion and related influencing factors were analyzed.Results There was no significant difference in the conversion rate (P＞ 0.05) between study group and control group after 3 months,but the conversion rate of study group was significantly lower than the control group after 6 months(6.00％ vs 20.41％,P＜0.05),12 months(10.00％ vs 24.49％,P＜0.05)and 18 months(10.00％ vs 28.57％,P＜0.05).CBT could effectively improve conditions for individuals with positive symptom (study group:5.30±3.62,5.04±3.89,4.38±4.13,5.26±3.65,5.94±4.19,control group:5.59±3.62,6.33±5.29,6.98 ±4.96,7.02±5.02,8.39±6.42,F=4.326,P=0.000) of UHR,but the improvement was not significant for negative individuals (F=1.555,P=0.215).CBT could be effective for disorganized symptom (F=6.901,P =0.010) and general symptom (F=7.752,P=0.006) as well.The poor family relationship was the risk factor of conversion to the schizophrenia (OR=3.411,95％CI=1.016-11.453,P=0.047).Conclusion CBT can effectively reduce the conversion rate of UHR individuals.CBT has a good remission effect on the positive symptoms,disintegrating symptoms and general symptoms of UHR.Family relationship affects prognosis of UHR individuals.

School Counselors' Recognition of the Ultra-High Risk for Psychosis

The ability to identify students at ultra-high risk (UHR) for psychosis in school settings is crucial for enabling appropriate referral to a clinician and positive therapeutic results. The aim of this study was to examine school counselors' recognition of the diagnosis and appropriate treatment recommendations for students at UHR for psychosis. In total, 132 school counselors completed surveys, including questions relating to a vignette about a student at UHR for psychosis. In total, 12.4% of the sample provided the correct diagnosis, much lower than that for other schizophrenia spectrum disorders and non-psychotic disorders, including depressive disorder. Although most school counselors preferred psychiatrists as the first-line treatment for students at UHR for psychosis, counseling centers were also mentioned as potential treatment options. In terms of medication, antipsychotics were preferred over other medication classes. It is necessary to design appropriate educational and training programs for school counselors to promote identification and effective referral of those at UHR for psychosis.

Validation of the Korean version of the 16-Item Prodromal Questionnaire in a Non-Help-Seeking College Population

OBJECTIVE: To examine the reliability and validity of the Korean version of the 16-item Prodromal Questionnaire (KPQ-16) in non-help-seeking university students. METHODS: Among 2,246 university students participated in the initial screening, 257 subjects with KPQ-16 scores ≥4 were interviewed. The criteria for ultra-high risk (UHR) of psychosis of the Comprehensive Assessment of At-Risk Mental States (CAARMS) were the gold standard for diagnosis. An exploratory modified version of the questionnaire (mKPQ-16), to which three items from the Eppendorf Schizophrenia Inventory were added, was also used to compensate for items on thought and cognitive problems. RESULTS: Seventeen subjects met the CAARMS criteria for UHR of psychosis. The area under the receiver operating characteristic curve (AUROC) was highest for the mKPQ-16 total score (AUROC=0.831, p < 0.001). The use of cutoff total scores of 7 for the mKPQ-16 and 6 for the KPQ-16 resulted in the best balance of sensitivity (76.5% and 64.7%, respectively) and specificity (75.4% and 71.2%, respectively). CONCLUSION: The Korean versions of the PQ-16 are good instruments for screening for psychosis risk in university students. This validation of a questionnaire version with a small number of items may make it feasible to screen large numbers of young adults in the community.

Severity of different factors of anhedonia in patients with schizophrenia spectrum disorders / 中国心理卫生杂志

Objective:To explore the severity and characteristic of different factors (consummatory anhedonia and anticipatory anhedonia) of anhedonia in schizophrenia spectrum disorders (ultra-high-risk,acute and stable).Methods:Twenty-two ultra-high-risk individuals according to the Structured Interview for Prodromal Syndromes,23 acute schizophrenia patients,18 stable schizophrenia patients according to diagnostic and statistical manual of mental disorder-Ⅳand 22 healthy controls were enrolled.The Positive and Negative Syndrome Scale (PANSS) for positive symptom,the Scale for the Assessment of Negative Symptoms(SANS) for negative symptom and the Temporal Experience of Pleasure Scale (TEPS) for anhedonia were administered to the participants.ANOVA test was used to compare the anhedonia of the four groups,and the Pearson correlation was used to evaluate the correlation between self report and clinician rating.Results:Consummatory anhedonia and abstract consummatory anhedonia of TEPS in ultra-high-risk group and acute group were higher than controls [(37 ± 9),(34 ± 8) vs.(44 ± 9),P ＜ 0.01],[(24 ± 6),(21 ±7) vs.(28 ±6),P ＜0.01],which have significant differences.There was no significant difference in the consummatory anhedonia and abstract consummatory anhedonia of TEPS between stable group and control group(P ＞ 0.05).There was no significant difference in anticipatory anhedonia among four groups(P ＞ 0.05).There was no significant correlation between TEPS and the anhedonia subscale of SANS in the ultra-high-risk group and the acute group(P ＞ 0.05).Consummatory anhedonia and anticipatory anhedonia of TEPS were significantly correlated with anhedonia subscale of SANS (r ＝-0.6--0.8) in stable group.Conclusions:Consummatory anhedonia,but not anticipatory anhedonia,may be in ultra-high-risk and acute phrase of schizophrenia individuals,whose self report are not consistent with clinician rating.Consummatory anhedonia may not be in stable patients,whose self report are consistent with clinician rating.

Evidence for Hypothalamus-Pituitary-Adrenal Axis and Immune Alterations at Prodrome of Psychosis in Males

We aimed to investigate the inflammatory substrate in psychosis by evaluating both the Hypothalamus-Pituitary-Adrenal axis function and immune state at prodrome. This involved the recruitment of Ultra High Risk (UHR) of Psychosis subjects, Healthy Controls (HC) and patients with established Schizophrenia (CHRON). Serum cortisol at 3 different times throughout the day was measured. The Dexamethasone Suppression Test was performed plus 12 circulating cytokines were measured. The UHR subjects presented increased IL-4 levels compared with both the HC and CHRON patients. In contrast the UHR differed only from the CHRON group regarding the endocrine parameters. In conclusion, IL-4 appears to play a key role at prodrome.

Impaired Social and Role Function in Ultra-High Risk for Psychosis and First-Episode Schizophrenia: Its Relations with Negative Symptoms

OBJECTIVE: Psychosocial dysfunction was a nettlesome of schizophrenia even in their prodromal phase as well as first episode and its relations with psychopathology were not determined. The aim of the present study was to examine whether the social and role function impairment was found in ultra-high risk for psychosis (UHR) individuals as well as first-episode schizophrenia patients and to explore its relations with psychopathology. METHODS: Thirty-seven normal controls, 63 UHR participants and 28 young, first-episode schizophrenia patients were recruited. Psychosocial functioning was examined by using Global function: Social and Role scale. Psychopathologies of positive, negative and depressive symptom were also measured. RESULTS: Social and role functioning in UHR were compromised at the equivalent level of those of first-episode schizophrenia patients. Multiple linear regression analysis revealed that social and role dysfunction was associated with negative symptoms in each UHR and first-episode schizophrenia group. CONCLUSION: These findings suggest that the significant impairment of social and role function may be appeared before the active psychosis onset at the level of extent to those of first-episode schizophrenia patients. The psychosocial intervention strategy especially targeting the negative symptoms should be developed and provided to individuals from their prepsychotic stage of schizophrenia.

Impaired Social and Role Function in Ultra-High Risk for Psychosis and First-Episode Schizophrenia: Its Relations with Negative Symptoms

OBJECTIVE: Psychosocial dysfunction was a nettlesome problem of schizophrenia even in their prodromal phase as well as in their first-episode. In addition, its relations with psychopathology were not determined. The aim of the present study was to examine whether the social and role function impairment was found in ultra-high risk for psychosis (UHR) individuals as well as first-episode schizophrenia patients and to explore its relations with psychopathology. METHODS: Thirty-seven normal controls, 63 UHR participants and 28 young, first-episode schizophrenia patients were recruited. Psychosocial functioning was examined by using Global function: Social and Role scale. Psychopathologies of positive, negative and depressive symptom were also measured. RESULTS: Social and role functioning in UHR were compromised at the equivalent level of those of first-episode schizophrenia patients. Multiple linear regression analysis revealed that social and role dysfunction was associated with negative symptoms in each UHR and first-episode schizophrenia group. CONCLUSION: These findings suggest that the significant impairment of social and role function may be appeared before the active psychosis onset at the level of extent to those of first-episode schizophrenia patients. The psychosocial intervention strategy especially targeting the negative symptoms should be developed and provided to individuals from their prepsychotic stage of schizophrenia.

A comparative study of cognitive functions in individuals at ultra high-risk for psychosis / 中华行为医学与脑科学杂志

Objective To investigate the differences of cognitive functions among ultra high-risk individuals(UHR),first-episode schizophrenia patients and healthy controls.Methods Twenty four participants meeting clinical inclusion criteria for initial prodromal states (IPS) selected from the first degree relatives of schizophrenia,23 first onset schizophrenia patients from the same family with UHR as well as 30 healthy controls were assessed with a comprehensive neuropsychological test battery including Trail Making Test (TMT),Stroop color word test and the Continuous Performance Test (CPT) to test the speed of information processing and sustained attention ability.Results ①The time of the Trail Making Test in UHR ((45.12±14.87) s) was shorter than first-episode schizophrenia patients((60.43± 19.30)s),but longer than healthy controls((27.13±7.74) s).The whole score of the Stroop color word test in UHR (28.46± 7.87) was higher than first-episode schizophrenia patients (18.78± 6.86),and lower than healthy controls (43.40±9.64).The score of the Continuous Performance Test in UHR (1.86 ± ± 1.05) was significanly higher than first-episode schizophrenia patients(1.17±0.67),but lower than healthy controls (2.63±0.67),and all these differences were significant (P＜0.01).②Taking age,years of education,occupation status,marital status and the Positive and Negative Syndrome Scale (PANSS) scores as the covariance,the analysis of covariance showed TMT and Stroop color word test were still statistically significant.Conclusion There are cognitive function changes in individuals at ultra high-risk for psychosis,lying between first-episode schizophrenia cases and healthy controls.

Emotional Dysregulation, Attributional Bias, Neurocognitive Impairment in Individuals at Ultra-High Risk for Psychosis and with Schizophrenia : Its Association with Paranoia / 대한정신분열병학회지

OBJECTIVES: Paranoia is a complex phenomenon, affected by a number of factors such as depression, trait anxiety, and attributional bias in schizophrenia. The aim of this study was to explore whether paranoia within continuum of clinical and subclinical states is associated with emotional dysregulation, attributional bias and neurocognitive impairment in whole individuals of normal controls, ultra-high risk (UHR) for psychosis and schizophrenia. METHODS: 101 normal controls, 50 participants at UHR for psychosis, and 49 schizophrenia patients were recruited. All subjects were asked to complete self-reported paranoia scale and emotional dysregulation scales including Rosenberg's self-esteem, Spielberg's state-trait anxiety inventory and Beck depression inventory. The attributional style was assessed by Ambiguous Intentions Hostility Questionnaire (AIHQ). Participants were also requested to complete the comprehensive neurocognitive battery. RESULTS: Multiple linear regression analysis showed that paranoia were found to be associated with emotional dysregulation (state anxiety, trait anxiety and depression), composite blaming bias in ambiguous situation, impairment of attention and working memory in whole participants [F (9, 190)=34.85, p<0.001, adjusted R2=0.61]. CONCLUSION: The main findings suggest that paranoia is a complex affective and cognitive structure that may be associated with emotional dysregulation, blaming bias and attention and working memory impairment in clinical and non-clinical paranoia.

Is psychodynamic psychotherapy an effective intervention for individuals at ultra-high risk (UHR) of psychosis?: a case report / É a psicoterapia psicodinâmica uma intervenção eficaz para indivíduos em risco ultra-alto (UHR) de psicose?: um relato de caso

OBJECTIVE: To report a case and to discuss the use of psychodynamic psychotherapy (PD-P) to treat individuals at ultra-high risk (UHR) of psychosis. METHODS: An individual at UHR was followed up for 24 months. The baseline evaluation included a psychiatric interview, the Structured Interview for Prodromal Symptoms (SIPS), the Scale of Prodromal Symptoms (SOPS), and neuropsychological assessment. He underwent weekly sessions of PD-P for 12 months and was followed up for 12 months after the end of PD-P. The evaluations were at baseline, after 6-, 12-, and 24-month follow-up. No medication was prescribed during the 24-month follow-up. RESULTS: The prodromal symptoms remitted. The initial total score on the SIPS/SOPS was 37 points. After the first 12 months of PD-P, there was a reduction to 12 points on the SIPS/SOPS score, which stabilized in the 24-month follow-up. There was also a slight improvement in his performance on the neuropsychological evaluations. CONCLUSION: This case report suggests that PD-P can reduce prodromal symptoms; nevertheless, a better understanding of the specificity and efficacy of PD-P as an option of treatment for UHR individuals is needed.

OBJETIVO: Relatar um caso e discutir o uso da psicoterapia psicodinâmica (PD-P) no tratamento de indivíduos com risco ultra-alto (UHR) para psicose. MÉTODOS: Um indivíduo UHR foi acompanhado por 24 meses. A avaliação inicial incluiu entrevista psiquiátrica, aplicação de instrumentos padronizados, Entrevista Estruturada Para Sintomas Prodrômicos (SIPS), a Escala de Sintomas Prodrômicos (SOPS) e avaliação neuropsicológica. O indivíduo teve sessões semanais de PD-P durante os primeiros 12 meses e continuou acompanhamento durante os 12 meses seguintes após o término da PD-P. Avaliações foram feitas no início do estudo e após 6, 12 e 24 meses de seguimento. Nenhuma medicação foi prescrita durante todo o seguimento. RESULTADOS: Os sintomas prodrômicos remitiram. Apresentou, ainda, discreta melhora no desempenho nas avaliações neuropsicológicas. CONCLUSÃO: Este relato sugere que a PD-P pode reduzir os sintomas prodrômicos, no entanto uma melhor compreensão da especificidade e eficácia da PD-P como uma opção de tratamento para os indivíduos UHR é necessária.

Prodromal Questionnaire: translation, adaptation to Portuguese and preliminary results in ultra-high risk individuals and first episode psychosis / Questionário Prodromal: tradução, adaptação para o português e resultados preliminares em indivíduos de ultra-alto risco e primeiro episódio psicótico

OBJECTIVE: The Prodromal Questionnaire (PQ) is a 92-item self-report screening tool for individuals at ultra-high risk (UHR) to develop psychosis. This study aims to present the translation to Portuguese and preliminary results in UHR and first episode (FE) psychosis in a Portuguese sample. METHODS: The PQ was translated from English to Portuguese by two bilingual researchers from the research program on early psychosis of the Instituto de Psiquiatria HCFMUSP, São Paulo, Brazil (ASAS - "Evaluation and Follow up of Adolescents and Young Adults in São Paulo") and back translated by two other researchers. The study participants (n = 11-) were evaluated through the Portuguese version of the Prodromal Questionnaire (PQ) and SIPS. RESULTS: The individuals at UHR (n = 7) presented a lower score than first episode patients (n = 4). The UHR mean scores and standard deviation on Portuguese version of the PQ were: 13.0 ± 10.0 points on positive symptoms subscale, and FE patients: 33.0 ± 10.0. CONCLUSION: The UHR and FE patients' of this study presented PQ scores similar to the ones found in the literature; what suggests that it is possible to use the PQ in Brazilian help-seeking individuals as a screening tool.

OBJETIVO: O Questionário Prodromal (PQ) é um instrumento de triagem e autorrelato com 92 itens para indivíduos com ultra-alto risco (UHR) para desenvolver psicose. Este estudo tem como objetivo apresentar a tradução desse questionário para português e seus resultados preliminares em uma amostra brasileira de UHR e primeiro episódio (FE) psicótico. MÉTODOS: O PQ foi traduzido do inglês para o português por dois pesquisadores bilíngues do programa de pesquisa sobre psicose precoce do Instituto de Psiquiatria HCFMUSP, São Paulo, Brasil (ASAS "Avaliação e Acompanhamento de Adolescentes e Jovens Adultos em São Paulo") e retrotraduzido por dois outros pesquisadores. Os participantes (n = 11) do estudo foram avaliados por meio da versão em português do Questionário de Prodromal (PQ) e SIPS. RESULTADOS: Os indivíduos com UHR (n = 7) apresentaram menor pontuação do que os pacientes de primeiro episódio (n = 4). Os escores médios e desvio-padrão dos indivíduos de UHR na versão em português do PQ foram: 13,0 ± 10,0 pontos na subescala de sintomas positivos, e dos pacientes de primeiro episódio: 33,0 ± 10,0. CONCLUSÃO: Neste estudo os indivíduos de UHR e pacientes de FE apresentaram pontuação do PQ semelhantes às encontradas na literatura, o que sugere a possibilidade de usar a PQ como um instrumento de triagem em indivíduos brasileiros que apresentam comportamento de procura de ajuda.

Pilot Study on Resting-State Functional Connectivity under the Effects of Familial Loading in People at Ultra-High Risk for Psychosis / 대한정신분열병학회지

OBJECTIVES: People at ultra-high risk for psychosis have heterogenous character and different long-term outcomes. We divided ultra-high risk subjects into two subgroups by presence of familial history and tried to find different pattern of functional connectivity of the default mode network (DMN) between the two groups in order to examine the effects familial loading. METHODS: Eleven subjects at clinical-high risk (CHR) group with familial history of psychiatric illness and nineteen subjects of CHR group without familial history were recruited. All the subjects were scanned using resting-state functional magnetic resonance imaging. A posterior cingulate cortex was the seed region of the analysis, and the DMN of the both high risk group were analyzed with voxel-wise two sample T test. RESULTS: The CHR group with familial history showed greater functional connectivity in the precuneus area in contrast with the other high risk subjects (peak-level t=5.49, p<0.001). There were no significant differences in total score on the Positive and Negative Syndrome Scale and Scales of Psychosis-risk Syndrome between the two groups. CONCLUSION: The study suggests that the abnormalities of functional connectivity between precuneus and posterior cingulate area may be associated with the genetic vulnerability of high risk trait.