2023

Filtering by: 2023
Nov
6
5:00 PM17:00
2023

Sleep Spindle Density as it relates to Positive Symptoms in Early Course Psychosis

Sleep Spindle Density as it relates to Positive Symptoms in Early Course Psychosis

Nataly Kaldawy (1), James Green (1), Nicolas Raymond (1), Finn Janak (1), Victor Zeng (1), Bengi Baran (2,4), Dan Denis (3), Robert Stickgold (1), Dara Manoach (4), Matcheri Keshavan (1)

1. Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA
2. Department of Psychological and Brain Sciences, University of Iowa
3. Department of Psychology, University of York, England
4. Sleep, Cognition, and Neuropsychiatry (SCAN) Lab, MGH

Abstract

Background: Schizophrenia and related psychoses are associated with deficits in sleep spindles during stage 2 non-REM sleep. How these sleep spindles relate to positive and negative symptoms of psychosis, however, is not well known. This study aims to understand the relationship between symptom severity of psychosis and sleep spindle density.
Methods: Data from 67 participants on the SPARCS sleep study was used, and participants were separated into EC (schizophrenia and related psychosis), FH (family high risk), and HC (healthy control) groups. Symptom severity of psychosis was measured using the PANSS and sleep spindle density was measured in spindles per minute using an EEG. We used a one-way ANOVA to assess the difference in sleep spindle densities between the three groups and multiple regression analyses to assess the difference between sleep spindle density and severity of psychosis.
Results: The EC group had significantly lower sleep spindle density than the FH and HC groups (F (2) = 4.71, p < 0.05). Multiple regression analyses demonstrated that PANSS Positive Symptoms (b = -0.08, p <0.05) and P6 (Suspiciousness/Persecution) (b = -0.29, p <0.05) were significantly predicted by sleep spindle density while adjusting for age and gender. PANSS Negative and General symptoms showed no correlation with spindle density.
Conclusion: These results show promise in conducting similar studies to further understand sleep spindles as a potential biomarker for schizophrenia. They also encourage further studies using structural and functional imaging to investigate the thalamus’ role in connecting sleep spindles to psychosis symptoms. Additionally, given the role of sleep spindles in memory consolidation, the relation between cognition, spindles, and psychotic symptoms needs to be further investigated. This research may improve the identification of early psychosis biomarkers, which may enhance accuracy of diagnosis and treatment, improving access and equity to effective early psychosis care.
Supported by NIMH grant MH MH107579

View Event →
Nov
6
5:00 PM17:00
2023

Psychosis Risk Screening Attitudes and Practices in College Mental Health Centers

Psychosis Risk Screening Attitudes and Practices in College Mental Health Centers

Harini Suresh M.D. , James Green B.A., Isabela Pena, Colette Potts Ed.M., Michelle Friedman-Yakoobian Ph.D.

Beth Israel Deaconess Medical Center, Response to Risk Research

Abstract

Background: The onset of psychotic disorders occurs most commonly in late adolescence/early adulthood. Routine screenings by college mental health clinicians and increased familiarity with identifying symptoms of psychosis may lead to earlier intervention and therefore improved treatment outcomes.
Methods: Participants included college-affiliated mental health clinicians in Massachusetts. Prior to virtual conference attendance on 11/9/2022, they completed a pre-survey assessing confidence and familiarity with psychosis screening tools, identification of symptoms, and community referrals – all topics included in the subsequent training. Clinicians completed a post-survey in 2/2023. Pearson correlations assessed associations between variables in baseline, and paired samples t-tests analyzed whether familiarity, confidence, and number of students with full psychosis or risk for psychosis screened significantly improved 3 months after training.
Results: Forty-eight clinicians completed the pre-intervention survey, of which 29% identified as counselors, 25% as psychologists, and 25% as social workers. Private university clinicians made up 75% of the cohort. Mean years in practice was 3-5 years. Participants were more likely to screen for other mental health concerns (85%) than psychosis (42%). Overall familiarity with psychosis significantly increased for the 25 participants who responded to the follow-up survey (t(24) = 4.51, p < 0.001, d = 0.9), with a large effect size (d = 0.9) associated with timepoints. Confidence in providing care for individuals with psychosis did not significantly increase at three-month follow-up (t(24) = 0.29, p = 0.77).
Conclusions: Our results suggest that delivery of this educational intervention for college mental health clinicians may lead to improved familiarity with psychosis. Higher familiarity was associated with more routine clinical screening of students for psychosis/psychosis risk. New resources for referral for youth at-risk or experiencing psychosis may help increase clinician confidence (e.g., MPATH). Other limitations include a lack of control group, clinician drop-out rate (from pre- to post- intervention), and self-reporting bias.

View Event →
Nov
6
5:00 PM17:00
2023

Baseline Reports of Traumatic Experiences as Correlates of Symptom Severity

Baseline Reports of Traumatic Experiences as Correlates of Symptom Severity in Naturalistic Psychiatric Treatment for Psychosis

Daphne Ying (1,2), Madison Natarajan (1,2,5), Heather Muir (1,2), Pegah Seif (1,2,3), Ananya Saluja (2), Kelsey Johnson (2), Iqra Imam (2), Nicolas Raymond (1,2,3), Oshin Kushwaha (1,2,3), Yusuf Sendil (1,2,3), Raquelle Mesholam-Gately (1,2),Margaret Guyer (5), Matcheri Keshavan (1,2,5), Paulo Lizano (1,2,3), Sarah Herold (1,2)

1. Advancing Services for Psychosis Integration and Recovery (ASPIRE) Clinic, Beth Israel Deaconess Medical Center
2. Department of Psychiatry, Harvard Medical School
3. Division of Translational Neuroscience, Beth Israel Deaconess Medical Center
4. Center for Early Detection Assessment and Response to Risk(CEDAR) Clinic, Brookline Center for Community Mental Health
5. Massachusetts Department of Mental Health

Abstract

Background: A history of trauma is associated with increased risk for psychosis, and individuals diagnosed with schizophrenia are 2.7 times more likely to have had adverse childhood experiences than healthy controls. Understanding a patient’s trauma history can provide important contextual information in understanding and treating their psychotic symptoms. Thus, it is important to elucidate the associations between trauma and psychosis in the naturalistic treatment of early psychosis patients. The present study aims to examine trauma rates within an early course psychosis clinic, whether traumatic life experiences are associated with baseline symptom severity, whilst considering which types of traumatic events are more strongly associated with psychosis symptoms. We hypothesize that sexual trauma will be most related to symptom severity compared to other types of trauma, as well as racial trauma for ethnic minorities.
Methods: Data was collected from intake assessments used in support of naturalistic early psychosis treatment across multiple MAPNET clinics. Intake assessments include various clinical measures including a self-report checklist of trauma (Life Events Checklist, LEC-5) and a measure of symptom severity (i.e., COMPASS-10, Colorado Symptom Index, and the Global Assessment of Functioning). Patients hold a variety of psychotic spectrum diagnoses, including schizophrenia spectrum disorders, affective psychoses, and substance-induced psychosis.
Results: As data collection is ongoing, analyses will be completed closer to the date of the conference. Means and standard deviations will be presented for both trauma experiences and psychosis symptoms to answer questions regarding descriptives. Additionally, a series of independent t-tests and chi-square analyses will be used to determine differences between trauma experiences as they relate to psychosis symptom severity.
Conclusions: Findings will help clarify the associations between trauma and psychosis symptom severity in naturalistic treatment for early psychosis. Incorporating trauma-informed psychosis interventions is one way in which clinics can foster a bio-psycho-social conceptualization of psychosis.

View Event →
Nov
6
5:00 PM17:00
2023

Baseline Substance Use as a Correlate of Symptom Severity and Medication Adherence

Baseline Substance Use as a Correlate of Symptom Severity and Medication Adherence in Naturalistic Psychiatric Treatment for Psychosis

Caroline Harris (1,2,3), Heather Muir (1,2,4,5), Madison Natarajan (1,2,5), Pegah Seif (1,2,3), Ananya Saluja (2), Kelsey Johnson (2), Iqra Imam (2), Nicolas Raymond (1,2,3), Oshin Kushwaha (1,2,3), Yusuf Sendil (1,2,3), Raquelle Mesholam-Gately (1,2), Margaret Guyer (5), Matcheri Keshavan (1,2,5), Sarah Herold (1,2),Paulo Lizano (1,2,3)

1. Advancing Services for Psychosis Integration and Recovery (ASPIRE) Clinic, Beth Israel Deaconess Medical Center
2 Department of Psychiatry, Harvard Medical School
3. Division of Translational Neuroscience, Beth Israel Deaconess Medical Center
4. Center for Early Detection Assessment and Response to Risk(CEDAR) Clinic, Brookline Center for Community Mental Health
5. Massachusetts Department of Mental Health

Abstract

Background: Recent studies have found that those with psychosis who have used substances are more likely to develop schizophrenia-spectrum disorders than those who avoid substance use. Additionally, substance use in psychosis patients is correlated with medication non-adherence and increases in symptom severity. Moreover, studies examining substance use, medication adherence, and symptom severity in psychosis have largely been conducted in the context of clinical trials, as opposed to naturalistic settings for the treatment of early psychosis. Thus, it is important to elucidate the associations between these variables in the naturalistic treatment of early psychosis patients. The present study aims to examine the substance use rates within an early course psychosis clinic, and whether baseline current substance use frequency, duration, and type of substance are associated with baseline symptom severity and medication adherence.
Methods: Data was collected from intake assessments used in support of naturalistic early psychosis treatment across multiple MAPNET clinics. Intake assessments include various measures including measures of substance use (WHO ASSIST 3.0, Abbreviated), symptom severity (i.e., COMPASS-10, Colorado Symptom Index, and the Global Assessment of Functioning), and medication adherence. Patients hold varying psychotic spectrum diagnoses, including schizophrenia spectrum disorders, affective psychoses, and substance-induced psychosis.
Results: As data collection is ongoing, analyses will be completed closer to the date of the conference. Means and standard deviations will be presented for both substance use and psychosis symptoms to answer questions regarding descriptives. A series of independent t-tests and chi-square analyses will be used to determine the associations between frequency, duration, type of substance use and baseline psychosis symptom severity and medication adherence.
Conclusions: Findings will help clarify the associations between substance use, symptom severity, and medication adherence in naturalistic treatment for early psychosis, and thus, could inform decisions regarding inclusion of substance-focused intervention in coordinated specialty care programs for psychosis.

View Event →
Nov
6
5:00 PM17:00
2023

Hospitalization Rates in Early Psychosis: 48 Month Outcomes for a Rural Coordinated Specialty Care Program

Hospitalization Rates in Early Psychosis: 48 Month Outcomes for Rural Coordinated Specialty Care and Community Care Programs

Betty DeAngelis, LICSW (1), Cassidy Lewis, BA (1), Melissa Weise, LICSW, PhD (1,2) John Knutsen, PhD (1,3)

1. ServiceNet Inc., Northampton, MA
2. School of Social Work, Smith College
3. Department of Psychology, Harvard University, Cambridge, MA

Abstract

Background: Hospitalization usage remains a significant contribution to overall health care costs in early psychosis, is associated with amplified symptom presentation, and can negatively impact treatment and intervention goals. However, hospitalization usage (and risk) has been shown to be markedly reduced in individuals who participate in coordinated specialty care programs (CSC) compared to usual care. Prevention and Recovery in Early Psychosis-West (PREP), a CSC for individuals living with early psychosis in Western MA, provides intensive, comprehensive, evidence-based outpatient milieu treatment for young adults to stabilize their lives, recover, and resume developmentally appropriate social and role functioning in their communities. Here we provide hospitalization rates data for individuals with early psychosis who participated in the PREP program and for those who received usual care over the past 48 months.
Methods: Descriptive analyses were used to explore demographic and inpatient psychiatric hospitalization rates (IPH) data from electronic health records for all PREP clients and usual care clients who received services for a minimum of three months between March 01, 2018, and March 31, 2022.
Results: Between 03/01/2018 and 03/31/2022 22% (n=78) of PREP clients had at least one hospitalization with an average IPH admission rate of 1.17 and a duration mean of 5.32 days, while 67% (n=30) of early psychosis individuals receiving usual care had at least one hospitalization with an average IPH admission rate of 2.20 and duration mean of 39.15 days.
Conclusion: Access to care and hospitalization usage remain robust challenges for young adults living with early psychosis in Western MA. However, in the past 48 months participants in the PREP program have demonstrated a markedly reduced overall IPH admission rate and duration compared to usual care. These data support the impact that a rural CSC can have on hospitalization usage in early psychosis when compared to usual care.

View Event →
Nov
6
5:00 PM17:00
2023

Examining Clinical and Social Predictors of Suicidal Ideation and Attempts in Individuals

Examining Clinical and Social Predictors of Suicidal Ideation and Attempts in Individuals at Clinical High Risk for Psychosis (CHR-p)

Julia Pfluger, B.S. (1,2,3), James Green, B.A (1,2,3), Wenhui Qi (1,2,3), Claire Goods B.S. (1,2,3), Joey Rodriguez (1,2,3), Michelle West, Ph.D (2), Michelle Friedman-Yakoobian Ph.D (1,2,3)

1. Psychosis Research Program, Beth Israel Deaconess Medical Center, Boston MA
2. CEDAR Clinic/Brookline Center for Community Mental Health, Boston MA
3. Harvard Medical School Department of Psychiatry, Boston MA

Abstract

Background: Research demonstrates that individuals who experience psychotic symptoms are at higher risk for suicidal ideation (SI) or suicide attempt (SA). However, the relationship between suicide risk and clinical high risk for psychosis (CHR-p) has yet to be clarified. Previous literature suggests that psychosis and suicidality may be associated through hopelessness, minority stress associated with minority identity status, interpersonal connections, and direct effects. Our study aims to examine the prevalence and risk factors of suicidality in youth at CHR-p.
Methods: Participants (n = 140) included CHR-p clients at the Center for Early Detection, Assessment, and Response to Risk (CEDAR), who participated in a baseline clinical assessment between 2017 and 2022. Instruments used measured psychosis symptoms, suicidality, clinical covariates, social and role functioning, and demographics. Frequency analyses assessed the prevalence of lifetime SI and SA. T-test and Chi-square examined variables associated with SI and SA. Logistic regression was implemented to examine the predictive accuracy, sensitivity, and specificity of variables flagged with a significant association with SI and SA.
Results: Results suggested that 65% of participants at CHR-p endorsed lifetime suicidal ideation, while 22.2% had at least 1 lifetime suicide attempt. In addition, participants who endorsed lifetime suicidal ideation also had significantly more hallucinations (t(130) = 2.46), hopelessness (t(109) = 2.09), depression (t(109) = 3.87), and trauma severity (t(62) = 2.03). The only significant predictor in the logistic regression predicting lifetime suicide attempts was a trauma diagnosis (b = 1.4).
Conclusion: Our results suggest that clients who meet diagnostic criteria for CHR-p have high rates of SI and SA. In addition, our findings suggest that in our sample, a trauma diagnosis was the strongest predictor of a suicide attempt. Longitudinal research is needed to explore changes in suicidality over time.

View Event →

Let’s stay connected.

Join our mailing list to receive updates, announcements about training, and more.