Most psychiatric disorders first emerge during adolescence and young adulthood. Non-specific, attenuated or transient symptoms combined with distress and a functional decline often become apparent before the full-threshold disorder emerges. However, early symptoms are often diffuse and dynamic in nature, and the developmental trajectories are heterotypic, with multiple syndromes as end-states. This challenges the usefulness of the traditional siloed and categorical approaches to diagnosing mental disorders; particularly for prevention and early intervention efforts. In the current symposium, research findings in the context of transdiagnostic approaches towards psychopathology, and their implications for early detection and intervention for mental disorders are presented and discussed.
In the first talk, Janko Kaeser will present the results of a study investigating positive psychotic symptoms as a marker of severity in a transdiagnostic sample of adolescent patients.
Second, Louise Destrée will report first results from a study that aimed to validate the Clinical High At-Risk Mental Health (CHARMS) criteria to identify young people at risk of developing a range of full-threshold disorders.
Third, Giulia Rinaldi will show the results of a study that examined the associations between coping strategies, Clinical High Risk for psychosis symptoms and the level of overall psychopathology or self-related health status, in both a general population and a clinical sample.
In the final talk, Ashwin Ratheesh will discuss the results of a large sample sized study exploring the inter-relationships between mood, psychotic and anxiety symptom stages, and their common risk factors to develop data-informed transdiagnostic stages for clinical staging models.
15:30 pm
Psychotic symptoms as a severity marker in a transdiagnostic clinical sample of adolescents: What is the significance of hallucinations?
Janko Mario Käser | University Hospital for Child and Adolescent Psychiatry and Psychotherapy Bern
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Authors:
Janko Mario Käser | University Hospital for Child and Adolescent Psychiatry and Psychotherapy Bern
PD Dr Corinna Reichl | University Hospital for Child and Aolescent Psychiatry and Psychotherapy Bern
Prof. Dr. Julian Koenig | University of Cologne
Dr. Stefan Lerch | University Hospital for Child and Adolescent Psychiatry and Psychotherapy Bern
Prof. Dr. Michael Kaess | University Hospital for Child and Adolescent Psychiatry and Psychotherapy Bern
Dr. Marialuisa Cavelti | University Hospital for Child and Adolescent Psychiatry and Psychotherapy Bern
Objectives: The aim of the present study was twofold: First, to examine the association between positive psychotic symptoms (PPS) and the severity of general psychopathology in a clinical sample of adolescents. Second, to explore whether delusions and hallucinations are differentially associated with psychopathology, particularly with self-harm.
Methods: 506 patients aged 11 to 17 years from a child and adolescent psychiatric service were included in the study. Based on the presence of psychotic symptoms, they were assigned to one of the following groups: no PPS (noPSS; n = 341), delusions only (del; n= 32), hallucinations only (hall; n = 80), and delusions & hallucinations (del&hall; n = 53). Generalized structural equation modeling was conducted to compare the groups with regard to a latent severity factor consisting of the number of psychiatric diagnoses, severity of depression, level of personality dysfunction, non-suicidal self-injury (NSSI), suicide attempts, perceived stress, and psychosocial impairments.
Findings: Participants with any PPS (del, hall, del&hall) scored higher on the severity factor than participants without PPS. Additionally, participants with both delusions and hallucinations showed higher severity scores than those with only delusions or hallucinations. Finally, participants with hallucinations only reported more frequent NSSI compared with those with delusions only. No such group difference was found for suicide attempts.
Implications: In adolescent patients, the presence of any PPS represents a general risk marker for more severe psychopathology and functional impairments, while the presence of hallucinations indicates a specific risk for NSSI. Early detection and treatment of PPS seems indicated in adolescent patients, irrespective of their diagnosis.
15:45 pm
The Clinical High At Risk Mental State (CHARMS) Pilot Study: Identifying Young People at Transdiagnostic Risk
Louise Destrée | Turner Institute for Brain and Mental Health, School of Psychological Sciences & Monash Biomedical Imaging Facility, Monash University
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Authors:
Louise Destrée | Turner Institute for Brain and Mental Health, School of Psychological Sciences & Monash Biomedical Imaging Facility, Monash University
Prof. Dr. Patrick McGorry | Orygen
Prof. Dr. Andrew Chanen | Orygen
Prof. Dr. Aswin Ratheesh | Orygen
Prof Christopher Davey | Orygen
Prof Andrea Polari | Orygen
Prof Paul Amminger | Orygen
Dr. Hok Pan Yuen | Orygen
Dr. Jessica Hartmann | Orygen
Rachael Spooner | Orygen
Prof. Dr. Barnaby Nelson | Orygen
Background: There is a need for the identification of symptomatic, help-seeking young people who might be at risk of disorder progression (to Stage 2 disorders, according to the clinical staging model). To address this, we developed clinical criteria: the Clinical High At-Risk Mental State (CHARMS) criteria.
Aims: The CHARMS study aimed to validate a set of transdiagnostic criteria to prospectively identify young people at risk of developing a range of full-threshold disorders: first episode psychosis, first episode mania, severe major depressive disorder, and borderline personality disorder.
Methods: 121 young people completed clinical evaluations at baseline, 6- and 12-month follow-ups. The Kaplan-Meier method was used to assess transition rates. Cox regression and LASSO were used to examine baseline predictors of transition by follow-up. Linear mixed effects modelling was used to examine symptom severity.
Results: 28% of at-risk individuals transitioned to a Stage 2 disorder at follow-up. This cohort was characterised by more severe symptoms. Most (96%) of Stage 2 transitions were to severe depression. Meeting criteria for multiple at-risk groups was associated with higher transition risk: meeting one at-risk group transition rate = 24%; meeting two at-risk groups transition rate = 17%, meeting three at-risk groups transition rate = 55%, meeting four at-risk groups transition rate = 50%.
Conclusions: The CHARMS criteria successfully identified a subgroup of young people at risk of developing a serious mental disorder. Severe depression was the main clinical outcome over this follow-up period, suggesting that it may be a ‘gateway’ to other serious mental illnesses.
16:00 pm
Coping strategies, locus of control and competence beliefs: their complex interactions with psychopathology and the role of Clinical High Risk (CHR) for psychosis
Giulia Rinaldi | University Hospital for Child and Adolescent Psychiatry and Psychotherapy Bern
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Authors:
Giulia Rinaldi | University Hospital for Child and Adolescent Psychiatry and Psychotherapy Bern
A/ Prof Frauke Schultze-Lutter | Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University
Naweed Osman | Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University
Prof. Dr. Michael Kaess | University Hospital for Child and Adolescent Psychiatry and Psychotherapy Bern
Prof. Dr. Benno G. Schimmelmann | University Hospital for Child and Adolescent Psychiatry and Psychotherapy Bern
Dr. Jochen Kindler | University Hospital for Child and Adolescent Psychiatry and Psychotherapy Bern
Dr. Chantal Michel | University Hospital for Child and Adolescent Psychiatry and Psychotherapy
Coping strategies, locus of control (LOC) and competence beliefs are important predictors of mental health which show complex interactions. Our study aimed to investigate them in the previously unexplored context of Clinical High Risk (CHR) status for psychosis.
Consequently, we tested 6 alternative structural equation models in a general population sample (N=523), after defining a measurement model with two latent factors of mental health: (1) Psychopathology (PP), including presence of mental disorders, global and psychosocial functioning levels, and (2) Self-Rated Health status (SRH).
These were the outcome variables in the model best fitting the data, where our hypothesis of a mediation by coping was supported: maladaptive coping mediated the negative effects of maladaptive LOC on PP and SRH, while adaptive coping mediated the association of competence and adaptive LOC with PP. Additionally, CHR symptoms mediated the negative impact of maladaptive coping on SRH and PP.
Validation in a clinical sample (N=378), however, only confirmed the latter result: adaptive and maladaptive coping only influenced SRH and PP via CHR symptoms, while competence beliefs directly impacted SRH.
Our results show that coping strategies are an important intervention target for mental health promotion, especially in the general population. Further, they support existing evidence about the substantial psychological burden associated with CHR symptoms. In clinical populations, focusing interventions on coping strategies could improve mental health quality through their impact on CHR symptoms. Moreover, an early focus on competence beliefs and LOC could avoid negative cascading effects on mental health and help promote psychological wellbeing.
16:15 pm
Empirically driven transdiagnostic stages in the development of mood, anxiety and psychotic symptoms in a cohort of youth followed from birth
Prof. Dr. Aswin Ratheesh | Orygen
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Authors:
Prof. Dr. Aswin Ratheesh | Orygen
Dylan Hammond | Orygen
Dr. Caroline Gao | Orygen
Prof. Steven Marwaha | Institute for Mental Health, School of Psychology, University of Birmingham
Prof. Dr. Andrew Thompson | Orygen
Dr. Jessica Hartmann | Orygen
Prof Christopher Davey | Orygen
Prof. Stanley Zammit | Population Health Sciences, Bristol Medical School, University of Bristol,
Prof. Michael Berk | Orygen
Prof. Dr. Patrick McGorry | Orygen
Prof. Dr. Barnaby Nelson | Orygen
Introduction: Staging models with transdiagnostic validity across mood, psychotic and anxiety disorders could advance early intervention efforts. However, there are few well supported operationalisations for such transdiagnostic models. We aimed to explore the inter-relationships between mood, psychotic and anxiety symptom stages, and their common risk factors to develop data-informed transdiagnostic stages.
Methods: We included participants from the Avon Longitudinal Study of Parents and Children (ALSPAC), a prospective ongoing birth cohort study. We developed operational thresholds for stages of depressive, hypomanic, anxiety and psychotic symptoms (at ages 18- 21years) based on the existing literature, refined further by expert consensus. We selected 1b level as the primary stage or outcome of interest as this was likely to be associated with the onset of need for care. We used network analyses and logistic regressions to examine the overlap between Stage 1b symptoms and their association with causal factors.
Results: Among 3269 young people with data available to determine all symptom stages, 64.3% were female and 96% Caucasian. Network analyses indicated that 1b level depressive, anxiety and psychotic symptom stages were inter-related while hypomania was not. Similarly, anxiety, depressive and psychotic 1b stages were associated with female sex, more emotional and behavioral difficulties in early adolescence, and life events in late adolescence. Hypomania was not related to any of these risk factors.
Discussion: Psychotic, anxiety and depressive symptoms could be combined to form a transdiagnostic stage in this cohort. Such empirical transdiagnostic stages could help with prognostication and indicated prevention in youth mental health.