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Aims: Childhood trauma is associated with an elevated risk for psychosis, but the psychological mechanisms involved remain largely unclear. This study aimed to investigate emotional and psychotic stress reactivity in daily life as a putative mechanism linking childhood trauma and clinical outcomes in individuals at ultra-high-risk (UHR) for psychosis. Methods: Experience sampling methodology was used to measure momentary stress, affect and psychotic experiences in the daily life of N = 79 UHR individuals in the EU-GEI High Risk Study. The Childhood Trauma Questionnaire was used to assess self-reported childhood trauma. Clinical outcomes were assessed at baseline, 1- and 2-year follow-up. Results: The association of stress with positive (β = −0.14, p = 0.010) and negative affect (β = 0.11, p = 0.020) was modified by transition status such that stress reactivity was greater in individuals who transitioned to psychosis. Moreover, the association of stress with negative affect (β = 0.06, p = 0.019) and psychotic experiences (β = 0.05, p = 0.037) was greater in individuals exposed to high v. low levels of childhood trauma. We also found evidence that decreased positive affect in response to stress was associated with reduced functioning at 1-year follow-up (B = 6.29, p = 0.034). In addition, there was evidence that the association of childhood trauma with poor functional outcomes was mediated by stress reactivity (e.g. indirect effect: B = −2.13, p = 0.026), but no evidence that stress reactivity mediated the association between childhood trauma and transition (e.g. indirect effect: B = 0.14, p = 0.506). Conclusions: Emotional and psychotic stress reactivity may be potential mechanisms linking childhood trauma with clinical outcomes in UHR individuals. [ABSTRACT FROM AUTHOR]

Importance: The development of adverse clinical outcomes in patients with psychosis has been associated with behavioral and neuroanatomical deficits related to emotion processing. However, the association between alterations in brain regions subserving emotion processing and clinical outcomes remains unclear.Objective: To examine the association between alterations in emotion processing and regional gray matter volumes in individuals at clinical high risk (CHR) for psychosis, and the association with subsequent clinical outcomes.Design, Setting, and Participants: This naturalistic case-control study with clinical follow-up at 12 months was conducted from July 1, 2010, to August 31, 2016, and collected data from 9 psychosis early detection centers (Amsterdam, Basel, Cologne, Copenhagen, London, Melbourne, Paris, The Hague, and Vienna). Participants (213 individuals at CHR and 52 healthy controls) were enrolled in the European Network of National Schizophrenia Networks Studying Gene-Environment Interactions (EU-GEI) project. Data were analyzed from October 1, 2018, to April 24, 2019.Main Measures and Outcomes: Emotion recognition was assessed with the Degraded Facial Affect Recognition Task. Three-Tesla magnetic resonance imaging scans were acquired from all participants, and gray matter volume was measured in regions of interest (medial prefrontal cortex, amygdala, hippocampus, and insula). Clinical outcomes at 12 months were evaluated for transition to psychosis using the Comprehensive Assessment of At-Risk Mental States criteria, and the level of overall functioning was measured through the Global Assessment of Functioning [GAF] scale.Results: A total of 213 individuals at CHR (105 women [49.3%]; mean [SD] age, 22.9 [4.7] years) and 52 healthy controls (25 women [48.1%]; mean [SD] age, 23.3 [4.0] years) were included in the study at baseline. At the follow-up within 2 years of baseline, 44 individuals at CHR (20.7%) had developed psychosis and 169 (79.3%) had not. Of the individuals at CHR reinterviewed with the GAF, 39 (30.0%) showed good overall functioning (GAF score, ≥65), whereas 91 (70.0%) had poor overall functioning (GAF score, <65). Within the CHR sample, better anger recognition at baseline was associated with worse functional outcome (odds ratio [OR], 0.88; 95% CI, 0.78-0.99; P = .03). In individuals at CHR with a good functional outcome, positive associations were found between anger recognition and hippocampal volume (ze = 3.91; familywise error [FWE] P = .02) and between fear recognition and medial prefrontal cortex volume (z = 3.60; FWE P = .02), compared with participants with a poor outcome. The onset of psychosis was not associated with baseline emotion recognition performance (neutral OR, 0.93; 95% CI, 0.79-1.09; P = .37; happy OR, 1.03; 95% CI, 0.84-1.25; P = .81; fear OR, 0.98; 95% CI, 0.85-1.13; P = .77; anger OR, 1.00; 95% CI, 0.89-1.12; P = .96). No difference was observed in the association between performance and regional gray matter volumes in individuals at CHR who developed or did not develop psychosis (FWE P < .05).Conclusions and Relevance: In this study, poor functional outcome in individuals at CHR was found to be associated with baseline abnormalities in recognizing negative emotion. This finding has potential implications for the stratification of individuals at CHR and suggests that interventions that target socioemotional processing may improve functional outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Alterations of the "pre-reflective" sense of first-person perspective (e.g., of the "basic self") are characteristic features of schizophrenic spectrum disorders and are significantly present in the prodromal phase of psychosis and in subjects at ultrahigh risk for psychosis (UHR). Studies in healthy controls suggest that neurobiological substrate of the basic self involves cortical midline structures, such as the anterior and posterior cingulate cortices. Neuroimaging studies have identified neuroanatomical cortical midline structure abnormalities in schizophrenic spectrum disorders. Objectives: i) To compare basic self-disturbances levels in UHR subjects and controls and ii) to assess the relationship between basic self-disturbances and alterations in cortical midline structures volume in UHR subjects. Methods: Thirty-one UHR subjects (27 antipsychotic-naïve) and 16 healthy controls were assessed using the 57-item semistructured Examination of Anomalous Self-Experiences (EASE) interview. All subjects were scanned using magnetic resonance imaging (MRI) at 3 T, and gray matter volume was measured in a priori defined regions of interest (ROIs) in the cortical midline structures. Results: EASE scores were much higher in UHR subjects than controls (p < 0.001). The UHR group had smaller anterior cingulate volume than controls (p = 0.037). There were no structural brain imaging alterations between UHR individuals with or without self-disturbances. Within the UHR sample, the subgroup with higher EASE scores had smaller anterior cingulate volumes than UHR subjects with lower EASE scores and controls (p = 0.018). In the total sample, anterior cingulate volume was inversely correlated with the EASE score (R = 0.52, p < 0.016). Conclusions: Basic self-disturbances in UHR subjects appear to be related to reductions in anterior cingulate volume. [ABSTRACT FROM AUTHOR]

Objective: The authors conducted a comprehensive meta-analysis of MRI region-of-interest and voxel-based morphometry (VBM) studies in posttraumatic stress disorder (PTSD). Because patients have high rates of comorbid depression, an additional objective was to compare the findings to a meta-analysis of MRI studies in depression.Method: The MEDLINE database was searched for studies from 1985 through 2016. A total of 113 studies met inclusion criteria and were included in an online database. Of these, 66 were selected for the region-of-interest meta-analysis and 13 for the VBM meta-analysis. The region-of-interest meta-analysis was conducted and compared with a meta-analysis of major depressive disorder. Within the region-of-interest meta-analysis, three subanalyses were conducted that included control groups with and without trauma.Results: In the region-of-interest meta-analysis, patients with PTSD compared with all control subjects were found to have reduced brain volume, intracranial volume, and volumes of the hippocampus, insula, and anterior cingulate. PTSD patients compared with nontraumatized or traumatized control subjects showed similar changes. Traumatized compared with nontraumatized control subjects showed smaller volumes of the hippocampus bilaterally. For all regions, pooled effect sizes (Hedges' g) varied from -0.84 to 0.43, and number of studies from three to 41. The VBM meta-analysis revealed prominent volumetric reductions in the medial prefrontal cortex, including the anterior cingulate. Compared with region-of-interest data from patients with major depressive disorder, those with PTSD had reduced total brain volume, and both disorders were associated with reduced hippocampal volume.Conclusions: The meta-analyses revealed structural brain abnormalities associated with PTSD and trauma and suggest that global brain volume reductions distinguish PTSD from major depression. [ABSTRACT FROM AUTHOR]

Background: a large and increasing number of older people in the UK are living in care homes. Dementia is a frequent reason underlying admission and determining care needs, but prevalence data are becoming increasingly outdated and reliant on brief screening instruments.Objective: to describe the prevalence and severity of dementia, depression, behavioural problems and relevant medication use in a representative sample of residential and nursing care home residents.Design/setting: a survey conducted in 15 randomly selected South East London care homes. Consensus clinical dementia diagnoses were made from multi-source information, and the Clinical Dementia Rating (CDR) Scale applied. Depression was ascertained using the Cornell Depression in Dementia Scale and psychological/behavioural problems using the Neuropsychiatric Inventory (NPI).Participants: three hundred and one residents with a mean (SD) age of 83.5 (9.8) and 65.8% female were included.Results: dementia (CDR 1–3) prevalence was 75.1% overall, 55.8% in residential homes, 91.0% in residential elderly mentally infirm care and 77.0% in nursing homes. Depression prevalences were 26.5, 22.0 and 29.6%, respectively, and mean (95% CI) NPI severity scores 3.99 (3.47–4.50), 6.34 (5.29–7.39) and 6.10 (5.50–6.70) with 87.3% of the sample exhibiting at least one NPI symptom. Antidepressants were prescribed in 25.6, 25.0 and 41.3%, respectively, and antipsychotics in 7.0, 34.1 and 19.1%.Conclusion: dementia is substantially more common in care homes than recorded diagnoses would suggest, but studies using brief screening instruments may overestimate prevalence. High prevalences of depressive and/or behavioural symptoms and psychotropic use suggest significant unmet need. [ABSTRACT FROM AUTHOR]

Background: a large and increasing number of older people in the UK are living in care homes. Dementia is a frequent reason underlying admission and determining care needs, but prevalence data are becoming increasingly outdated and reliant on brief screening instruments.Objective: to describe the prevalence and severity of dementia, depression, behavioural problems and relevant medication use in a representative sample of residential and nursing care home residents.Design/setting: a survey conducted in 15 randomly selected South East London care homes. Consensus clinical dementia diagnoses were made from multi-source information, and the Clinical Dementia Rating (CDR) Scale applied. Depression was ascertained using the Cornell Depression in Dementia Scale and psychological/behavioural problems using the Neuropsychiatric Inventory (NPI).Participants: three hundred and one residents with a mean (SD) age of 83.5 (9.8) and 65.8% female were included.Results: dementia (CDR 1–3) prevalence was 75.1% overall, 55.8% in residential homes, 91.0% in residential elderly mentally infirm care and 77.0% in nursing homes. Depression prevalences were 26.5, 22.0 and 29.6%, respectively, and mean (95% CI) NPI severity scores 3.99 (3.47–4.50), 6.34 (5.29–7.39) and 6.10 (5.50–6.70) with 87.3% of the sample exhibiting at least one NPI symptom. Antidepressants were prescribed in 25.6, 25.0 and 41.3%, respectively, and antipsychotics in 7.0, 34.1 and 19.1%.Conclusion: dementia is substantially more common in care homes than recorded diagnoses would suggest, but studies using brief screening instruments may overestimate prevalence. High prevalences of depressive and/or behavioural symptoms and psychotropic use suggest significant unmet need. [ABSTRACT FROM AUTHOR]

Persons with severe mental illness (SMI) are at increased risk of criminal offending, particularly violent offending, as compared with the general population. Most offenders with SMI acquire convictions prior to contact with mental health services. This study examined offending among 301 individuals experiencing their first episode of psychosis. Patients provided information on sociodemographic and clinical variables and completed a neurological soft sign examination and neuropsychological tests. Additional information was extracted from clinical files and official criminal records. The results show that 33.9% of the men and 10.0% of the women had a record of criminal convictions, and 19.9% of the men and 4.6% of the women had been convicted of at least one violent crime. Proportionately more male and female patients than men and women in the general UK population had prior convictions for violent crimes. In a multivariate model including background and clinical variables, only one variable distinguished the male offenders. African-Caribbean ethnicity was associated with a threefold increase in the odds of offending (odds ratio = 3.84, 95% confidence interval 1.03-14.37). Offenders, as compared with non-offenders, obtained significantly lower premorbid and current intelligence quotient scores and similar scores on tests of neurological soft signs, working memory and executive functions. At contact with mental health services for a first episode of psychosis, significant numbers of patients have records of criminal convictions and thereby a high risk for future violent behaviour. These patients require specific interventions, in addition to medication, to reduce offending and aggressive behaviour. [ABSTRACT FROM AUTHOR]

Background Individuals at clinical high risk (CHR) for psychosis have approximately a 25% chance of transitioning to psychosis in the first 2 years after first presentation to clinical services. A key aim in this field is to determine the risk of conversion for an individual meeting the criteria for CHR based on clinical, demographic and neuropsychological measures. An individualized risk calculator incorporating 8 risk factors based on these measures has recently been developed by the researchers from the North American Prodrome Longitudinal Study (NAPLS-2) and tested in their dataset of CHR participants. Methods We examined the risk factors from the NAPLS risk calculator in the EU-GEI (EU funded gene environment interaction) high risk study. The EU-GEI high risk study is a longitudinal multi-centre study including 9 sites in Europe, 1 site in Australia and 1 site in Brazil. At baseline, the study included 345 CHR individuals of which 65 later developed psychosis. The NAPLS risk calculator includes 8 risk factors and for each risk factor we attempted to harmonise the EU-GEI measures to the corresponding NAPLS measure. We used multivariate cox regression to determine the standardised hazard ratio for transition to psychosis for the 8 risk factors. To compare each of the NAPLS and EU-GEI hazard ratios we used a meta-analytical framework to calculate a combined hazard ratio and to examine heterogeneity between the effect sizes. Results In terms of the 8 risk factors, only the CAARMS unusual thought + non-bizarre ideas (corresponding to NAPLS SIPS P1+P2) was significantly associated with transition to psychosis, standardised hazard ratio = 1.51 (95%CI 1.01–2.23), p=0.046. Hazard ratios for the remaining risk factors varied from 0.73 to 1.41. The meta-analysis combining EU-GEI and NAPLS data did not indicate heterogeneity for any of the 8 measures, suggesting no systematic differences in the risk factors between the two studies. Discussion The test of the NAPLS risk factors in the independent EU-GEI high risk sample showed support for unusual thought content and non-bizarre ideas being predictive of later transition to psychosis. We were not able to replicate decline in functioning and lower scores in verbal learning memory as predictive of transition to psychosis as seen in the NAPLS study. However, our meta-analytical comparison showed no systematic differences in the hazard ratios for all 8 risk factors between both studies suggesting broad comparability between the samples. [ABSTRACT FROM AUTHOR]

Background The development of adverse clinical outcomes in psychosis has been associated with behavioral and neuroanatomical changes related to emotional processing (Aleman & Kahn, 2005; Philips & Seidman, 2008). However, the relationship between emotional processing deficits and neuroanatomy in subjects at clinical high risk of psychosis (CHR), and their relationship to longitudinal outcomes, remains unclear. The primary aim of the present study was to investigate the association between facial emotional recognition and grey matter volume (GMV) in a large cohort of CHR individuals compared to healthy controls, and their relationship with subsequent clinical outcomes. Methods Structural imaging scans at 3T and a computer-based measure of emotional processing (Degraded Facial Affect Recognition task, DFAR), were collected at baseline from 53 healthy controls (mean age: 23.3 SD ± 3.9; 52.8% male) and 213 CHR subjects (mean age: 22.9 SD ± 4.7; 50.7% male) participating in the multi-centre EU-GEI study (data pooled from 9 sites). CHR subjects were then clinically monitored for 12 months and clinical outcomes were assessed in terms of transition/non-transition to psychosis (CAARMS criteria) and the level of overall functioning (Global Assessment of Function scale; GAF). Structural images were preprocessed with voxel-based morphometry in SPM12. DFAR performance (total, happy, angry, fear and anger) was analyzed with repeated measures ANOVA at baseline (HC/CHR as between-group factor and DFAR as within-subject factor, adjusted for age, gender, IQ and site); and with binary logistic regression at the 12-month follow-up point (adjusting for the same variables). One-way ANOVAs in SPM12 were specified to examine interactions between group status (HC/CHR, CHR-T/CHR-NT, CHR-GO/CHR/PO) and DFAR performance (total, happy, angry, fear and anger), adjusting for the same variables. Statistical inferences were made at p<.05 after voxel-wise FWE correction within four pre-defined anatomical regions of interest (ROI: amygdala, hippocampus, insula, anterior cingulate cortex/medial prefrontal cortex -ACC/MPFC-). Results At baseline, DFAR performance did not differ between HC and CHR groups and was not significantly associated with GMV in our ROIs. At the 12-month follow-up point, 39 CHR subjects showed good overall functioning (GAF≥65), whereas 93 CHR subjects had a poor functional outcome (GAF score<65); 44 CHR subjects developed a psychotic disorder and 169 did not. Compared to subjects with a good functional outcome, CHR subjects with poor overall functioning showed exacerbated recognition of angry facial emotion (p=.030), decreased GMV in ACC and hippocampus (both p=.033 FWE), and a significantly different (inverse) association between angry facial emotion recognition and hippocampal volume compared to CHR subjects with good functioning (p=.037 FWE). CHR subjects who developed psychosis did not show significant differences in DFAR performance or significant associations between DFAR and GMV compared with CHR subjects who did not become psychotic. Discussion These findings indicate that adverse global functional outcomes in people at CHR of psychosis (but not transition to psychosis) are associated with baseline deficits in the recognition of angry facial emotion, which are in turn directly related to hippocampal volume decreases compared to CHR subjects with good functional outcomes. This has implications not only for stratification of CHR subjects according to baseline behavioral and volumetric characteristics, but also suggest potential preventative avenues for poorer outcomes focused on social cognitive and emotional processes. [ABSTRACT FROM AUTHOR]

The authors reflect on the significance of conducting research surveys on the long-term care for older people with dementia who are staying in elderly care homes in Great Britain. The authors state that the researches on dementia could provide up-to-date information regarding its prevalence and substantial impact. They relate the study conducted by Aldred and colleagues, wherein the medical records of 331 residents with dementia in 65 care homes from 2002-2003 in Leeds, England were surveyed.