Two-Year Clinical and Functional Outcomes of an Asian Cohort at Ultra-High Risk of Psychosis.

Background: To determine the 2-year clinical and functional outcomes of an Asian cohort at ultra-high risk (UHR) of psychosis. Method: This was a longitudinal study with a follow-up period of 2 years on 255 help-seeking adolescents and young adults at UHR of psychosis managed by a multi-disciplinary mental health team in Singapore. Clients received case management, psychosocial, and pharmacological treatment as appropriate. Data comprising symptom and functional outcomes were collected over the observation period by trained clinicians and psychiatrists. Results: The 2-year psychosis transition rate was 16.9%, with a median time to transition of 168 days. After 2 years, 14.5% of the subjects had persistent at-risk symptoms while 7.5% developed other non-psychotic psychiatric disorders. 38.4% of the cohort had recovered and was discharged from mental health services. The entire cohort's functioning improved as reflected by an increase in the score of the Social and Occupational Functioning Assessment Scale during the follow-up period. Predictors to psychosis transition included low education level, baseline unemployment, a history of violence, and brief limited intermittent psychotic symptoms, while male gender predicted the persistence of UHR state, or the development of non-psychotic disorders. Conclusion: Use of the current UHR criteria allows us to identify individuals who are at imminent risk of developing not just psychosis, but also those who may develop other mental health disorders. Future research should include identifying the needs of those who do not transition to psychosis, while continuing to refine on ways to improve the UHR prediction algorithm for psychosis.

Affective and cognitive theory of mind abilities in youth with borderline personality disorder or major depressive disorder.

BACKGROUND: Theory of mind (ToM) is an important social cognitive ability that has been investigated in BPD, with inconsistent findings indicating impaired, comparable, and enhanced ToM in BPD. This study aimed to clarify and extend previous findings by investigating affective and cognitive ToM abilities in youth early in the course of BPD, by including a clinical comparison group of youth with major depressive disorder (MDD). METHODS: Female participants aged 15-24 years diagnosed with BPD (n = 41) or MDD (n = 37) completed the Reading the Mind in the Eyes Test (RMET) and Happé's Cartoon Task, measures of affective and cognitive dimensions of ToM, respectively. RESULTS: The BPD group performed significantly worse than the MDD group on the affective ToM task, even after controlling for age, intelligence and depressive symptoms. Results for cognitive ToM were not significantly different. CONCLUSIONS: Finding of poorer performance on a measure of affective ToM, in BPD youth, relative to youth with MDD early in the course of BPD suggest a developmental failure of sociocognitive abilities needed for mentalising and which are theorised as giving rise to core features of BPD. Future research should employ more naturalistic paradigms to study social cognition and should assess individuals even earlier in the course of BPD.

Support for Wellness Achievement Programme (SWAP): clinical and demographic characteristics of young people with at-risk mental state in Singapore.

AIM: Individuals with at-risk mental state (ARMS) experience subtle changes in thinking, behaviour and emotion before their first psychotic episode. Research has shown intervention provided during this period could delay, reduce, or even prevent the conversion to psychosis. In March 2008, the Support for Wellness Achievement Programme (SWAP) was launched for the assessment and treatment of patients with ARMS in Singapore. This paper examines the sociodemographic and clinical characteristics of patients at baseline. METHODS: In total, 384 patients were screened and 155 were accepted into the service. All patients were evaluated using the Comprehensive Assessment of At-Risk Mental State (CAARMS). Severity of psychopathology was assessed by Positive and Negative Syndrome Scale for Schizophrenia (PANSS) and levels of functioning were assessed using the Social and Occupational Functioning Assessment Scale (SOFAS). RESULTS: The mean age of the patients was 21.0 years (standard deviation (SD) = 3.5) and 69.7% were men, 42.6% had a relative with a mental health problem and 69.8% met the criterion solely for the attenuated symptoms group. The mean PANSS total score was 48.9 (SD = 10.8). There was also a high rate of comorbidity with 34.8% having depression and 20.0% had anxiety disorders. The mean baseline SOFAS score was 51.5 (SD = 9.8), indicating moderate impairment in their functioning. CONCLUSION: These preliminary findings have highlighted that our data are similar to other ARMS programmes, and in addition to the management of ARMS, there is a need to treat both the comorbidities and impairment in social occupational functioning.