ABSTRACT
Despite practice guidelines recommending caregiver inclusion for assessment of mental health problems in adolescents, clinical high-risk (CHR) assessment tools that target attenuated psychosis symptoms rely solely on self-report. As many individuals in the clinical high-risk phase are expected to be adolescents, and programs of CHR research routinely recruit participants as young as twelve, parent input regarding adolescents' symptoms and functioning may help to inform clinical conceptualizations. No assessment tool targeting CHR symptoms has been developed for this purpose. We created a caregiver-report version of the 12-item Prime Screen-Revised and administered the measure to caregivers of 52 youth ages 12-19 referred by mental health providers for CHR study participation. Youth completed the Prime Screen-Revised as well as the Structured Interview for Psychosis Risk Syndromes (SIPS). Caregiver responses demonstrated poor agreement with youth ratings on Prime Screen-Revised (r=.09), but moderate agreement with clinician ratings (r=.41). The addition of caregiver screening data to youth self-report scores significantly improved a linear regression predicting clinician ratings. Using a threshold of four or more endorsements, the combined use of parent and adolescent responses accurately classified 75% of respondents with regard to SIPS-determined CHR status. Findings suggest that involving caregivers may help to improve the specificity of CHR screening and assessment procedures.
Subject(s)
Parent-Child Relations , Parents/psychology , Psychotic Disorders/diagnosis , Psychotic Disorders/psychology , Adolescent , Caregivers/psychology , Child , Female , Humans , Male , Psychiatric Status Rating Scales , Risk Factors , Young AdultABSTRACT
OBJECTIVE: In early-onset schizophrenia (EOS), the earliest structural brain volumetric abnormalities appear in the parietal cortices. Early exposure to cannabis may represent an environmental risk factor for developing schizophrenia. This study characterized cerebral cortical gray matter structure in adolescents in regions of interest (ROIs) that have been implicated in EOS and cannabis use disorders (CUD). METHOD: T1-weighted magnetic resonance images were acquired from adolescents with EOS (n = 35), CUD (n = 16), EOS + CUD (n = 13), and healthy controls (HC) (n = 51). Using FreeSurfer, brain volume was examined within frontal, temporal, parietal and subcortical ROIs by a 2 (EOS versus no EOS) × 2 (CUD versus no CUD) design using multivariate analysis of covariance. In ROIs in which volumetric differences were identified, additional analyses of cortical thickness and surface area were conducted. RESULTS: A significant EOS-by-CUD interaction was observed. In the left superior parietal region, both "pure" EOS and "pure" CUD had smaller gray matter volumes that were associated with lower surface area compared with HC. A similar alteration was observed in the comorbid group compared with HC, but there was no additive volumetric deficit found in the comorbid group compared with the separate groups. In the left thalamus, the comorbid group had smaller gray matter volumes compared with the CUD and HC groups. CONCLUSIONS: These preliminary data indicate that the presence of a CUD may moderate the relationship between EOS and cerebral cortical gray matter structure in the left superior parietal lobe. Future research will follow this cohort over adolescence to further examine the impact of cannabis use on neurodevelopment.
