Exploring specific predictors of psychosis onset over a 2-year period: A decision-tree model.

AIM: The fluctuating symptoms of clinical high risk for psychosis hamper conversion prediction models. Exploring specific symptoms using machine-learning has proven fruitful in accommodating this challenge. The aim of this study is to explore specific predictors and generate atheoretical hypotheses of onset using a close-monitoring, machine-learning approach. METHODS: Study participants, N = 96, mean age 16.55 years, male to female ratio 46:54%, were recruited from the Prevention of Psychosis Study in Rogaland, Norway. Participants were assessed using the Structured Interview for Psychosis Risk Syndromes (SIPS) at 13 separate assessment time points across 2 years, yielding 247 specific scores. A machine-learning decision-tree analysis (i) examined potential SIPS predictors of psychosis conversion and (ii) hierarchically ranked predictors of psychosis conversion. RESULTS: Four out of 247 specific SIPS symptom scores were significant: (i) reduced expression of emotion at baseline, (ii) experience of emotions and self at 5 months, (iii) perceptual abnormalities/hallucinations at 3 months and (iv) ideational richness at 6 months. No SIPS symptom scores obtained after 6 months of follow-up predicted psychosis. CONCLUSIONS: Study findings suggest that early negative symptoms, particularly those observable by peers and arguably a risk factor for social exclusion, were predictive of psychosis. Self-expression and social behaviour might prove relevant entry points for early intervention in psychosis and psychosis risk. Testing study results in larger samples and at other sites is warranted.

Job- and schoolprescription: A local adaptation to individual placement and support for first episode psychosis.

AIM: Individual placement and support (IPS) for first episode psychosis (FEP) has proven effective for employment and education, but yields differing results across geographical regions. Local adaptations may be necessary for various reasons, such as regional differences in employment- and welfare services; in educational opportunities and job markets. The aim of this study was to investigate the efficacy of an adapted Norwegian intervention offering early IPS for education and employment to persons with FEP. METHOD: Matched control (N = 66) study with a 1-year early IPS intervention and a 2-year follow up. A rating of fidelity to the IPS model was conducted. RESULTS: Fidelity was "good." Adaptations to the model included the use of internships and flexible combinations of education and employment. Thirty out of 33 participants completed the intervention. Fourteen were in competitive employment >20 h/wk post intervention, compared to 2 in the control group. Fifteen participants were enrolled in education >20 h/wk, 10 of whom also had employment >20 h/wk and 3 < 20 h/wk, compared to 5 in the control group, with 2 having employment <20 h/wk on the side. Symptom levels did not predict outcome. CONCLUSION: The School- and JobPrescription adaptation of IPS, allowing for temporary internships as a step towards obtaining the goal of paid competitive employment and facilitating flexible combinations of employment and education, showed encouraging results. These were however not sustained after closure of the intervention. At the 2-year follow up, Job- and SchoolPrescription advantages had waned, underscoring the point in IPS that support should be time-unlimited.

"Everyone Needs a Friend Sometimes" - Social Predictors of Long-Term Remission In First Episode Psychosis.

Background: Predictors of long-term symptomatic remission are crucial to the successful tailoring of treatment in first episode psychosis. There is lack of studies distinguishing the predictive effects of different social factors. This prevents a valid evaluating of their independent effects. Objectives: To test specific social baseline predictors of long-term remission. We hypothesized that first, satisfaction with social relations predicts remission; second, that frequency of social interaction predicts remission; and third, that the effect of friend relationship satisfaction and frequency will be greater than that of family relations satisfaction and frequency. Material and Methods: A sample of first episode psychosis (n = 186) completed baseline measures of social functioning, as well as clinical assessments. We compared groups of remitted and non-remitted individuals using generalized estimating equations analyses. Results: Frequency of social interaction with friends was a significant positive predictor of remission over a two-year period. Neither global perceived social satisfaction nor frequency of family interaction showed significant effects. Conclusions: The study findings are of particular clinical importance since frequency of friendship interaction is a possibly malleable factor. Frequency of interaction could be affected through behavioral modification and therapy already from an early stage in the course, and thus increase remission rates.

Child factors associated with parent involvement in usual clinical care of children and adolescents: a national register study.

The study examined the role of child level characteristics of age, gender, disorder and experience of family breakdown on parent involvement in the treatment of children and adolescents in a usual clinical care setting. Data from the national register of 20,856 children and adolescents treated in psychiatric hospitals and clinics in Norway in 2002 were analyzed using a three-level hierarchical model. Consultations attended by the child, mother and father were constructed as level 1, child characteristics as level 2 and clinics as level 3. Results indicated that 42% of the variance was explained by within-family differences of consultations and 56% by child characteristics. Only 2% of the variance was explained by clinic-to-clinic differences. In the total model, child factors of gender, disorder and family breakdown (but not age) were significant predictors of consultation with children and parents. Therapists should take into account the role of the gender, disorder and family breakdown in promoting parent involvement and hindering premature termination.

Parent-youth discrepancy in the assessment and treatment of youth in usual clinical care setting: consequences to parent involvement.

BACKGROUND: Involving parents in the treatment of youth referred for mental health problems is an important agenda. Parent involvement is associated with treatment retention, greater family participation, and positive outcomes. The main goal of the present study was to examine the role of youth and parent report of the youth's psychopathology and interpersonal problems on parent involvement in outpatient treatment of the youth. METHODS: Data were gathered from 63 referred youth in treatment in an outpatient clinic. Subjects reported the youth's interpersonal problems and problem syndromes. The direct account of the youth and parents was examined for association with two indices of parent involvement, namely, the mothers' behavioral involvement (BI) and personal emotional involvement (PEI) in the treatment process. RESULTS: Results showed that while direct reports of the youth and parents were not significant predictors of parent involvement, discrepancy scores predicted parent involvement. Further, there were twice as many scales of interpersonal problems that were related to parent involvement as the syndrome scales. CONCLUSION: The ability of discrepancy scores in predicting parent involvement underscores that it is not only a risk factor for later development of adverse outcomes, but also related with essential treatment processes. Clinicians may be able to address these issues and aid in treatment processes leading to desired outcomes.