Early intervention models suggest psychological interventions given to an individual exposed to a traumatic event may prevent the onset of trauma-related symptoms.

Cognitive therapies are based on the theory that an individual’s perception of a situation influences his or her emotional response to it. They aim to help people identify distorted thinking and to modify existing beliefs. Cognitive processing therapy is a type of cognitive therapy that involves psychoeducation, written accounts about the traumatic event, and cognitive restructuring to address beliefs about the event’s meaning and its implications.

Cognitive behavioural therapy (CBT) is one of the most common psychological treatments that are effective for the treatment of PTSD. CBT challenges distorted, negative thinking patterns associated with the trauma. It aims to help people develop more adaptive cognitions and behaviours, and to rethink assumptions and reactions to the event.

Exposure therapies to desensitise people to trauma-related memories by exposing them to specific and non-specific cues related to the trauma.

Eye movement desensitisation and reprocessing (EMDR) involves the patient focussing on a disturbing image, memory, emotion, or cognition associated with the trauma while the therapist initiates rapid voluntary eye movements. This is based on the observation that the intensity of traumatic memories can be reduced through eye movements, although the underlying mechanisms remain unclear.

Other therapies include narrative therapy, which can be used to help people reconstruct a consistent narrative about the trauma. Psychoeducation may help normalise stress reactions. Psychodynamic therapy can help people process the trauma emotionally and gain a better understanding of their responses to it. Supportive therapy involves counsellors giving support, listening, and helping people talk over their problems. Family therapy focusses on improving family communication and functioning.

What is the evidence on effectiveness of psychotherapy for prevention of PTSD?

Moderate quality evidence found a medium-sized reduction in rates of PTSD diagnosis, and more improvement in PTSD symptoms for up to one month following psychological therapy (mostly CBT) in children and adolescents exposed to trauma. However, these effects were not significant over the longer term. Direct comparisons between interventions showed no differences in rates of PTSD diagnosis in children receiving CBT, EMDR, or supportive therapy. However, CBT was better than EMDR, play therapy, and supportive therapy for PTSD symptom improvement.

There was a small reduction in PTSD diagnoses in adults exposed to trauma by 3-6 months following multiple-session, early psychological interventions. However, there were no differences immediately post-treatment or at 7-12 months after treatment. There were also no differences in PTSD symptom severity, depression, anxiety, or quality of life. Authors report a high risk of bias in the included trials.

August 2021

Image: ©Antonio Diaz – stock.adobe.com

The post Therapies for prevention of PTSD appeared first on NeuRA Library.

Scientific understanding of the neurobiological changes occurring during PTSD onset shows memory consolidation appears particularly vulnerable to disruption in the first six hours after trauma, making this a crucial period for intervention for prevention of PTSD. This technical commentary presents the evidence on pharmaceutical interventions administered during this period. Please also see the psychotherapy for prevention of PTSD topic.

What is the evidence on medications for the prevention of PTSD?

Hydrocortisone is a glucocorticoid, which attenuates heightened fear response through increased removal of fear-inducing memories. Moderate to low quality evidence found a medium to large, reduced risk of PTSD within 3-6 months post-trauma in people with severe physical illness or injury receiving hydrocortisone post-trauma. Risks were not assessed in these samples, so contraindications need checking.

There was no benefit of hydrocortisone over placebo after 6 months post-trauma. There were also no benefits of propranolol, oxytocin, gabapentin, fish oil, dexamethasone, escitalopram, imipramine, or chloral hydrate for preventing PTSD at any time frame. Studies are few and small.

August 2021

Image: ©Soni’s – stock.adobe.com

The post All pharmaceutical treatments for prevention of PTSD appeared first on NeuRA Library.

People deemed at high risk for bipolar disorder can be identified by having a family history of a mood disorder and/or having subclinical symptoms that are not severe enough for a diagnosis. Subclinical symptoms include depression, difficulty with concentration, episodic mood swings, anxiety, sleep disturbances, and sensitivity to stress. Familial risk accompanied by mood dysregulation or other mood symptomatology could help define the population at high risk of bipolar disorder. Early intervention involves identifying and treating these high-risk individuals as repeated mood episodes put people at risk of poor symptomatic and functional recovery.

What is the evidence for psychosocial treatments for people at high risk for bipolar disorder?

Moderate quality evidence finds benefits of early interventions, particularly family-orientated therapies, for improving mood and functioning in people aged between 9 and 30 years who are at risk of bipolar disorder.

November 2021

Image: ©gstockstudio – stock.adobe.com

The post Therapies for high-risk groups appeared first on NeuRA Library.

People deemed at high risk for bipolar disorder can be identified by having a family history of a mood disorder and/or having subclinical symptoms that are not severe enough for a diagnosis. Subclinical symptoms include depression, difficulty with concentration, episodic mood swings, anxiety, sleep disturbances, and sensitivity to stress. Familial risk accompanied by mood dysregulation or other mood symptomatology could help define the population at high risk of bipolar disorder. Early intervention involves identifying and treating these high-risk individuals as repeated mood episodes put people at risk of poor symptomatic and functional recovery.

What is the evidence for medication in people at high risk for bipolar disorder?

Moderate to low quality evidence finds aripiprazole was significantly superior to placebo in improving mood, ADHD, and functioning scores in children and adolescents with a parent with bipolar disorder. There were no effects of valproate compared to placebo.

November 2021

©Photographee.eu – stock.adobe.com

The post Medication for high-risk groups appeared first on NeuRA Library.

Early detection of bipolar disorder can prevent or delay the onset of the disorder, and improve clinical outcomes in people who develop it.

What is the evidence regarding early detection of bipolar disorder?

Moderate to high quality evidence suggests large effects of having psychotic symptoms or a family history of bipolar disorder as risk factors for transition to bipolar disorder in people with major depression. There was a medium-sized effect of higher risk of transition to bipolar disorder with early age of onset of depression, and a small effect of having a family history of any mood disorder. The risk of transition to bipolar disorder was greatest in the early stages of having a major depressive disorder (up to 5 years).

Moderate quality evidence suggests subclinical symptoms preceding an initial mood episode last around 27 months, and subclinical symptoms preceding a recurrent mood episode last around 1 month. Common subclinical symptoms (in order of decreasing prevalence) are too much energy, diminished ability to think, indecisiveness, pressured speech, talkative, elated mood, academic or work difficulties, insomnia and depressed mood. Less common subclinical symptoms (in order of decreasing prevalence) are over-productive/goal-directed behaviour, agitation, rage attacks, racing thoughts, anxiety, decreased need for sleep, irritable mood, fatigue, distractibility, sleep disturbance, disinhibition, weight loss/loss of appetite, hyperactivity, suicidal thoughts, feeling of worthlessness, mood swings, delusions, unkempt or bizarre appearance, guilt, and auditory hallucinations. Rare subclinical symptoms (in order of decreasing prevalence) are loss of interest, somatic complaints, being over-sensitive, hypersexuality, flight of ideas, hypersomnia, weight gain, self-harm, suicide attempts, and visual hallucinations.

Low quality evidence is unable to determine the accuracy of instruments used for early detection. Review authors conclude that the Child Behavioral Checklist – Pediatric Bipolar Disorder Phenotype and the General Behavioral Inventory – Revised have the better validity and utility than the Hypomanic Personality Scale, the Behavioral Activation Scale or the Family History Scale, and that more studies assessing these scales are required.

September 2021

Image: ©Photographee.eu – stock.adobe.com

The post Early detection appeared first on NeuRA Library.

A key target of early intervention is “indicated prevention” for individuals at high risk of psychosis who have been identified with early signs of the disorder, but do not meet any diagnostic criteria. There are two key approaches for identifying people with early signs. The first approach is based on Huber’s Basic Symptoms, which focuses on a detailed way of describing phenomenological (subjective) disturbances in the domains of perception, cognition, language, motor function, will, initiative and level of energy, and stress tolerance. Because the basic symptoms refer only to subtle subjectively experienced abnormalities, they may reflect an earlier phase in the disease process than the second approach. The second approach identifies at-risk mental states as a combination of a family history of psychosis plus non-specific symptoms and recent decline in functioning, recent onset attenuated psychotic symptoms with a decline in functioning, and brief, limited, intermittent psychotic symptoms.

Early intervention treatments for people identified at a high risk of psychosis often comprise both pharmaceutical and psychosocial therapies, consequently this table presents the evidence for both.

What is the evidence for treatments for high-risk groups?

Moderate quality evidence suggests cognitive behavioural therapy (CBT) may reduce the risk of transition to psychosis for up to two years when compared to various control conditions, with no differences in symptoms, functioning, study retention or quality of life. There were some advantages of ziprasidone plus needs-based interventions for improving attenuated psychotic symptoms when compared to needs-based interventions alone, CBT plus needs-based interventions, or risperidone plus CBT and needs-based interventions.

There were no differences in rates of transitioning to psychosis between needs-based interventions with versus without additional components (aripiprazole, olanzapine, ziprasidone, risperidone, glycine or D-serine, omega-3, CBT, integrated therapies, or family therapies). There were no differences between CBT, omega-3, or cognitive remediation and various control conditions for social functioning, and no differences between NMDAR (glutamate) modulators, CBT, omega-3, risperidone, family therapies, or cognitive remediation and control conditions for negative symptoms.

May 2022

Image: ©gstockstudio – stock.adobe.com

The post Therapies and medications for high-risk groups appeared first on NeuRA Library.

There are two key approaches for identifying people with early signs that may suggest a high risk of developing psychosis or schizophrenia. The first approach is based on Huber’s Basic Symptoms, which focuses on a detailed way of describing phenomenological (subjective) disturbances. Because the basic symptoms refer only to subtle subjectively experienced abnormalities, they may reflect an earlier phase in the disease process than the second approach, which identifies at-risk mental states as a combination of; a family history of psychosis (familial risk) plus non-specific symptoms and recent decline in functioning; recent onset Attenuated Psychotic Symptoms with decline in functioning; and Brief Limited Intermittent Psychotic Symptoms.

What is the evidence for cognitive functioning in high-risk groups?

Moderate to high quality evidence found medium-sized effects of poorer verbal learning, reasoning and problem-solving, visual memory, verbal memory, working memory, olfaction, visual learning, and executive functioning in people at clinical high-risk for psychosis compared to controls. There were also small effects of poorer general intelligence, processing speed, attention/vigilance, premorbid intelligence, visuospatial ability, social cognition, and motor functioning in people at clinical high risk for psychosis.

High quality evidence shows people at clinical high risk of psychosis and familial high risk of psychosis are similarly impaired on processing speed, verbal and visual memory, attention and language fluency when compared with controls. People at familial high risk were more impaired on premorbid and current IQ than those at clinical high risk, and those at clinical high risk were more impaired on visuospatial working memory than those at familial high risk.

Moderate quality evidence found medium-sized effects of poorer verbal learning, visual memory, and executive functioning in people at high-risk of psychosis who made the transition to psychosis compared to people at high-risk of psychosis who did not make the transition to psychosis. There were small effects of poorer processing speed, attention/vigilance, and general intelligence in those who transitioned to psychosis, with no differences in working memory, premorbid intelligence, olfaction, or motor functioning.

Moderate quality evidence finds medium-sized effects of better verbal learning, general intelligence, and executive functioning in people at high-risk of psychosis compared to people with first-episode psychosis. There were no differences in premorbid intelligence or processing speed.

High quality evidence finds small improvements in cognition over time in people at ultra-high risk of psychosis and in people with first-episode psychosis.

March 2022

Image: ©ninefotostudio – stock.adobe.com

The post Cognition in high-risk groups appeared first on NeuRA Library.

Early detection refers to the correct identification of individuals who are at high risk of developing schizophrenia, with an emphasis on the development of frank psychosis. Generally, there are two approaches that dictate the characteristics used as markers for detection. The first is the ultra-high risk approach which focuses on a triad of at-risk mental states defined as having a family history of psychosis plus non-specific symptoms and recent decline in functioning, recent onset of attenuated psychotic symptoms with decline in functioning, and brief, intermittent and limited psychotic symptoms. The other approach is based on Huber’s Basic Symptoms, which focuses on a detailed way of describing subjective disturbances, and may be an earlier indicator of risk.

What is the evidence for early detection of psychosis?

Moderate to high quality evidence found the mean rate of transition to psychosis in those assessed as being at clinical high risk is around 16% by 2 years and 29% by 3 years. In adolescents and young adults (16-24 years) who were diagnosed with attenuated psychotic syndrome, transition rates were 11% by 6 months, 15% by 12 months, 20% by 2 years months, and 23% by 3 years. In children (<18 years) assessed as being at clinical high risk, transition rates were between 17% and 20% by 1 year follow-up and between 7% and 21% by 2 year follow-up. 36% of children and adolescents recovered from their clinical high risk status by 6-year follow-up, and 40% continued to meet clinical high risk criteria without transition to psychosis.

People assessed as being at clinical high risk of obsessive-compulsive disorder were at higher risk of psychosis transition than people assessed as being at clinical high risk of bipolar disorder, which in turn had higher risk of psychosis than people assessed as being at high risk of depression. The rate of transition to psychosis was one third the rate of transition to non-psychotic disorders in people at assessed as being at clinical high risk for any non-psychotic disorder.

Studies with older samples reported higher transition rates than studies with younger samples, and more recent publications reported lower transition rates than older publications. Studies using the basic symptoms approach reported higher transition rates than studies using the ultra-high risk approach. Studies of people receiving psychosocial treatments for high risk groups (e.g., cognitive behavioural therapy) reported lower transition rates than studies of people receiving standard care (e.g., case management). Studies of people on antipsychotics also reported lower transition rates than studies of people not on antipsychotics.

Moderate to high quality evidence suggests instruments based on ultra-high risk criteria have good sensitivity and moderate specificity. Moderate to low quality evidence found the Assessment of Basic Symptoms Scale has good sensitivity and moderate specificity. This indicates validated tools are generally good at correctly identifying individuals who do develop psychosis, but not as good at identifying individuals who do not develop psychosis.

Moderate quality evidence suggests the model with the best predictive value (86%) for transition to psychosis was a clinical model including odd beliefs, marked impairment in role functioning, blunted affect, auditory hallucinations, and anhedonia/asociality. A biological model using grey matter volume, and a neurocognitive model using IQ, verbal memory, executive functioning, attention, processing speed, and speech perception, both had positive predictive values of ~83%. An environmental model with a positive predictive value of 63% involved urbanicity, social-sexual aspects, and social-personal adjustment. The best combination model had a positive predictive value of 82% and involved disorganised communication, suspiciousness, verbal memory deficit, and decline in social functioning.

February 2022

Image: ©Photographee.eu – stock.adobe.com

The post Early detection appeared first on NeuRA Library.