Predicting Psychosis

"Prevention is better than cure", so they say. And in most branches of medicine, preventing diseases, or detecting early signs and treating them pre-emptively before the symptoms appear, is an important art.

Not in psychiatry. At least not yet. But the prospect of predicting the onset of psychotic illnesses like schizophrenia, and of "early intervention" to try to prevent them, is a hot topic at the moment.

Schizophrenia and similar illnesses usually begin with a period of months or years, generally during adolescence, during which subtle symptoms gradually appear. This is called the "prodrome" or "at risk mental state". The full-blown disorder then hits later. If we could detect the prodromal phase and successfully treat it, we could save people from developing the illness. That's the plan anyway.

But many kids have "prodromal symptoms" during adolescence and never go on to get ill, so treating everyone with mild symptoms of psychosis would mean unnecessarily treating a lot of people. There's also the question of whether we can successfully prevent progression to illness at all, and there have been only a few very small trials looking at whether treatments work for that - but that's another story.

Stephan Ruhrmann et al. claim to have found a good way of predicting who'll go on to develop psychosis in their paper Prediction of Psychosis in Adolescents and Young Adults at High Risk. This is based on the European Prediction of Psychosis Study (EPOS) which was run at a number of early detection clinics in Britain and Europe. People were referred to the clinics through various channels if someone was worried they seemed a bit, well, prodromal

Referral sources included psychiatrists, psychologists, general practitioners, outreach clinics, counseling services, and teachers; patients also initiated contact. Knowledge about early warning signs (e.g., concentration and attention disturbances, unexplained functional decline) and inclusion criteria was disseminated to mental health professionals as well as institutions and persons who might be contacted by at-risk persons seeking help.

245 people consented to take part in the study and met the inclusion criteria meaning they were at "high risk of psychosis" according to at least one of two different systems, the Ultra High Risk (UHR) or the COGDIS criteria. Both class you as being at risk if you show short lived or mild symptoms a bit like those seen in schizophrenia i.e.

COGDIS: inability to divide attention; thought interference, pressure, and blockage; and disturbances of receptive and expressive speech, disturbance of abstract thinking, unstable ideas of reference, and captivation of attention by details of the visual field...

UHR: unusual thought content/delusional ideas, suspiciousness/persecutory ideas, grandiosity, perceptual abnormalities/hallucinations, disorganized communication, and odd behavior/appearance... Brief limited intermittent psychotic symptoms (BLIPS) i.e. hallucinations, delusions, or formal thought disorders that resolved spontaneously within 1 week...

Then they followed up the 245 kids for 18 months and saw what happened to them.

What happened was that 37 of them developed full-blown psychosis: 23 suffered schizophrenia according to DSM-IV criteria, indicating severe and prolonged symptoms; 6 had mood disorders, i.e depression or bipolar disorder, with psychotic features, and the rest mostly had psychotic episodes too short to be classed as schizophrenia. 37 people is 19% of the 183 for whom full 18 month data was available; the others dropped out of the study, or went missing for some reason.

Is 19% high or low? Well, it's much higher than the rate you'd see in randomly selected people, because the risk of getting schizophrenia is less than 1% lifetime and this was only 18 months; the risk of a random person developing psychosis in any given year has been estimated at 0.035% in Britain. So the UHR and COGDIS criteria are a lot better than nothing.

On the other hand 19% is far from being "all": 4 out of 5 of the supposedly "high risk" kids in this study didn't in fact get ill, although some of them probably developed illness after the 18 month period was over.

The authors also came up with a fancy algorithm for predicting risk based on your score on various symptom rating scales, and they claim that this can predict psychosis much better, with 80% accuracy. As this graph shows, the rate of developing psychosis in those scoring highly on their Prognostic Index is really high. (In case you were wondering the Prognostic Index is [1.571 x SIPS-Positive score >16] + [0.865 x bizarre thinking score] + [0.793 x sleep disturbances score] + [1.037 x SPD score] + [0.033 x (highest GAF-M score in the past year – 34.64)] + [0.250 x (years of education – 12.52)]. Use it on your friends for hours of psychiatric fun!)

However they came up with the algorithm by putting all of their dozens of variables into a big mathematical model, crunching the numbers and picking the ones that were most highly correlated with later psychosis - so they've specifically selected the variables that best predict illness in their sample, but that doesn't mean they'll do so in any other case. This is basically the "voodoo" non-independence problem that has so troubled fMRI, although the authors, to their credit, recognize this and issue the appropriate cautions.

So overall, we can predict psychosis, sometimes, but far from perfectly. More research is needed. One of the proposed additions to the new DSM-V psychiatric classification system is "Psychosis Risk Syndrome" i.e. the prodrome; it's not currently a disorder in DSM-IV. This idea has been attacked as an invitation to push antipsychotic drugs on kids who aren't actually ill and don't need them. On the other hand though, we shouldn't forget that we're talking about terrible illnesses here: if we could successfully predict and prevent psychosis, we'd be doing a lot of good.

Ruhrmann, S., Schultze-Lutter, F., Salokangas, R., Heinimaa, M., Linszen, D., Dingemans, P., Birchwood, M., Patterson, P., Juckel, G., Heinz, A., Morrison, A., Lewis, S., Graf von Reventlow, H., & Klosterkotter, J. (2010). Prediction of Psychosis in Adolescents and Young Adults at High Risk: Results From the Prospective European Prediction of Psychosis Study Archives of General Psychiatry, 67 (3), 241-251 DOI: 10.1001/archgenpsychiatry.2009.206

Predicting Psychosis

"Prevention is better than cure", so they say. And in most branches of medicine, preventing diseases, or detecting early signs and treating them pre-emptively before the symptoms appear, is an important art.

Not in psychiatry. At least not yet. But the prospect of predicting the onset of psychotic illnesses like schizophrenia, and of "early intervention" to try to prevent them, is a hot topic at the moment.

Schizophrenia and similar illnesses usually begin with a period of months or years, generally during adolescence, during which subtle symptoms gradually appear. This is called the "prodrome" or "at risk mental state". The full-blown disorder then hits later. If we could detect the prodromal phase and successfully treat it, we could save people from developing the illness. That's the plan anyway.

But many kids have "prodromal symptoms" during adolescence and never go on to get ill, so treating everyone with mild symptoms of psychosis would mean unnecessarily treating a lot of people. There's also the question of whether we can successfully prevent progression to illness at all, and there have been only a few very small trials looking at whether treatments work for that - but that's another story.

Stephan Ruhrmann et al. claim to have found a good way of predicting who'll go on to develop psychosis in their paper Prediction of Psychosis in Adolescents and Young Adults at High Risk. This is based on the European Prediction of Psychosis Study (EPOS) which was run at a number of early detection clinics in Britain and Europe. People were referred to the clinics through various channels if someone was worried they seemed a bit, well, prodromal

Referral sources included psychiatrists, psychologists, general practitioners, outreach clinics, counseling services, and teachers; patients also initiated contact. Knowledge about early warning signs (e.g., concentration and attention disturbances, unexplained functional decline) and inclusion criteria was disseminated to mental health professionals as well as institutions and persons who might be contacted by at-risk persons seeking help.

245 people consented to take part in the study and met the inclusion criteria meaning they were at "high risk of psychosis" according to at least one of two different systems, the Ultra High Risk (UHR) or the COGDIS criteria. Both class you as being at risk if you show short lived or mild symptoms a bit like those seen in schizophrenia i.e.

COGDIS: inability to divide attention; thought interference, pressure, and blockage; and disturbances of receptive and expressive speech, disturbance of abstract thinking, unstable ideas of reference, and captivation of attention by details of the visual field...

UHR: unusual thought content/delusional ideas, suspiciousness/persecutory ideas, grandiosity, perceptual abnormalities/hallucinations, disorganized communication, and odd behavior/appearance... Brief limited intermittent psychotic symptoms (BLIPS) i.e. hallucinations, delusions, or formal thought disorders that resolved spontaneously within 1 week...

Then they followed up the 245 kids for 18 months and saw what happened to them.

What happened was that 37 of them developed full-blown psychosis: 23 suffered schizophrenia according to DSM-IV criteria, indicating severe and prolonged symptoms; 6 had mood disorders, i.e depression or bipolar disorder, with psychotic features, and the rest mostly had psychotic episodes too short to be classed as schizophrenia. 37 people is 19% of the 183 for whom full 18 month data was available; the others dropped out of the study, or went missing for some reason.

Is 19% high or low? Well, it's much higher than the rate you'd see in randomly selected people, because the risk of getting schizophrenia is less than 1% lifetime and this was only 18 months; the risk of a random person developing psychosis in any given year has been estimated at 0.035% in Britain. So the UHR and COGDIS criteria are a lot better than nothing.

On the other hand 19% is far from being "all": 4 out of 5 of the supposedly "high risk" kids in this study didn't in fact get ill, although some of them probably developed illness after the 18 month period was over.

The authors also came up with a fancy algorithm for predicting risk based on your score on various symptom rating scales, and they claim that this can predict psychosis much better, with 80% accuracy. As this graph shows, the rate of developing psychosis in those scoring highly on their Prognostic Index is really high. (In case you were wondering the Prognostic Index is [1.571 x SIPS-Positive score >16] + [0.865 x bizarre thinking score] + [0.793 x sleep disturbances score] + [1.037 x SPD score] + [0.033 x (highest GAF-M score in the past year – 34.64)] + [0.250 x (years of education – 12.52)]. Use it on your friends for hours of psychiatric fun!)

However they came up with the algorithm by putting all of their dozens of variables into a big mathematical model, crunching the numbers and picking the ones that were most highly correlated with later psychosis - so they've specifically selected the variables that best predict illness in their sample, but that doesn't mean they'll do so in any other case. This is basically the "voodoo" non-independence problem that has so troubled fMRI, although the authors, to their credit, recognize this and issue the appropriate cautions.

So overall, we can predict psychosis, sometimes, but far from perfectly. More research is needed. One of the proposed additions to the new DSM-V psychiatric classification system is "Psychosis Risk Syndrome" i.e. the prodrome; it's not currently a disorder in DSM-IV. This idea has been attacked as an invitation to push antipsychotic drugs on kids who aren't actually ill and don't need them. On the other hand though, we shouldn't forget that we're talking about terrible illnesses here: if we could successfully predict and prevent psychosis, we'd be doing a lot of good.

Ruhrmann, S., Schultze-Lutter, F., Salokangas, R., Heinimaa, M., Linszen, D., Dingemans, P., Birchwood, M., Patterson, P., Juckel, G., Heinz, A., Morrison, A., Lewis, S., Graf von Reventlow, H., & Klosterkotter, J. (2010). Prediction of Psychosis in Adolescents and Young Adults at High Risk: Results From the Prospective European Prediction of Psychosis Study Archives of General Psychiatry, 67 (3), 241-251 DOI: 10.1001/archgenpsychiatry.2009.206

Holy Week

This week is Holy Week. And our 2nd week off of school. Last week we were on Spring Break. This week we don't have school because it's Holy Week and I go to a Catholic School. But my Dad had to go back to work. He has to work until Wednesday.

We've been going to church almost every day during Lent. We go Tuesday, Thursday, and Friday nights. And on Sundays. I go every morning for school. My Dad and my Nana go on Wednesdays at lunch time too!

But we all enjoy going to church. This week, we are going every day. I wish my Nana was going to be here for Easter. But she is going to visit her family. We're going to miss her. I'm going to miss her a lot. Because I don't have school this week. Last week, she came over a few times. We cooked and baked. And she helped me with my sewing. We had a lot of fun! :) C

Practicals

Uh oh. Science education in British schools is in trouble, say the BBC:

'Too few' practical experiments in science lessons

For according to an online poll conducted by the Science Learning Center,

A combination of curriculum pressure and over-assessment is strait-jacketing science teachers and limiting the amount of time spent on vital classroom practicals, according to a survey...96% of the 1,339 science teachers and technicians surveyed said they were in some way hindered from undertaking science practical work.

How, well, scientific this poll was we are not told, and as a poll it only tells us what people think, not whether practicals are actually getting harder to do or less common. But still, let's suppose it's true. Does it matter? Practicals are widely seen as an important part of science education. But what good they really do?

One answer is that practicals teach you experimental skills that you'll need if you want to do research. That would be good if it were true, but it's not. I went to a good school and we had many practicals, but as far as I can remember not one of them was useful to me when studying science at university or as a researcher. In physics we did stuff with springs and pendulums. None of the physicists I know have touched one since school. In biology, I looked at plenty of yeast down a microscope, and counted a bunch of shells on a beach, but not once did I run a Western blot or do some PCR, basic techniques that almost all biologists actually use in real life.

Maybe practicals serve to "help students to develop skills such as observation", as 82% of the polled science teachers think? If so, they are not very good at it: what usually happened at my school anyway was that most people's experiments wouldn't work for whatever reason, so instead of observing and recording the actual results, people looked up what the answer was meant to be and fudged their data to fit. Even when everything did work this didn't teach us to observe, because we already knew what to expect, so it simply confirmed that we'd done it right.

Perhaps they're there to help us "develop an understanding of scientific enquiry" (80%)? I hope not, because doing real science is almost exactly the opposite of doing a practical. You don't get told what to do, you have to decide what to do in order to answer a question; you don't get told what methods to use; you don't know what the answer should be; and you don't know that your experiment will even work, because no-one has done it before.

In my experience practicals succeed at doing one thing: they make science lessons less boring. They're essentially entertainment. This is not a criticism - anything that keeps kids interested in science is a good thing, and a well-run practical is a lot more interesting than a textbook will ever be. So they're important. But we shouldn't pretend that practicals actually show people how to do science.

For that matter, though, neither does anything else: university practicals ("labs") don't either, although they're more likely to involve useful experimental techniques. Doing science is a skilled activity, like swimming: you can't be taught it in the abstract. A good teacher might help by holding your hand and making sure you don't sink, but ultimately you learn by diving in and actually doing it.

Practicals

Uh oh. Science education in British schools is in trouble, say the BBC:

'Too few' practical experiments in science lessons

For according to an online poll conducted by the Science Learning Center,

A combination of curriculum pressure and over-assessment is strait-jacketing science teachers and limiting the amount of time spent on vital classroom practicals, according to a survey...96% of the 1,339 science teachers and technicians surveyed said they were in some way hindered from undertaking science practical work.

How, well, scientific this poll was we are not told, and as a poll it only tells us what people think, not whether practicals are actually getting harder to do or less common. But still, let's suppose it's true. Does it matter? Practicals are widely seen as an important part of science education. But what good they really do?

One answer is that practicals teach you experimental skills that you'll need if you want to do research. That would be good if it were true, but it's not. I went to a good school and we had many practicals, but as far as I can remember not one of them was useful to me when studying science at university or as a researcher. In physics we did stuff with springs and pendulums. None of the physicists I know have touched one since school. In biology, I looked at plenty of yeast down a microscope, and counted a bunch of shells on a beach, but not once did I run a Western blot or do some PCR, basic techniques that almost all biologists actually use in real life.

Maybe practicals serve to "help students to develop skills such as observation", as 82% of the polled science teachers think? If so, they are not very good at it: what usually happened at my school anyway was that most people's experiments wouldn't work for whatever reason, so instead of observing and recording the actual results, people looked up what the answer was meant to be and fudged their data to fit. Even when everything did work this didn't teach us to observe, because we already knew what to expect, so it simply confirmed that we'd done it right.

Perhaps they're there to help us "develop an understanding of scientific enquiry" (80%)? I hope not, because doing real science is almost exactly the opposite of doing a practical. You don't get told what to do, you have to decide what to do in order to answer a question; you don't get told what methods to use; you don't know what the answer should be; and you don't know that your experiment will even work, because no-one has done it before.

In my experience practicals succeed at doing one thing: they make science lessons less boring. They're essentially entertainment. This is not a criticism - anything that keeps kids interested in science is a good thing, and a well-run practical is a lot more interesting than a textbook will ever be. So they're important. But we shouldn't pretend that practicals actually show people how to do science.

For that matter, though, neither does anything else: university practicals ("labs") don't either, although they're more likely to involve useful experimental techniques. Doing science is a skilled activity, like swimming: you can't be taught it in the abstract. A good teacher might help by holding your hand and making sure you don't sink, but ultimately you learn by diving in and actually doing it.

BOM DIA, MEUS LINDOS AMIGOS!!!

Quero aproveitar e agradecer a todos os meus amigos.
Dizer que estou um pouco ausente em função do trabalho.. Estou com aulas de reforço em casa, para ajudar as crianças com dificuldades de aprendizagem..Está muito corrido. mas sempre estarei te visitando.
Só peço um poquinho de carinho e compreensão. Esta muito puxado.
Mas vou manter contato com você.
És um SER muito Especial na minha VIDA!!!

A VOTAÇÃO CONTINUA ATÉ A MANHÃ.
CONTAREI COM O SEU VOTO.

Vote no Melhor Texto AQUI! 8. Sandra Andrade: Onde cresceu o meu Pai: Bela e pequena, Ituporanga

Poetas-Um Voo Livre-

Sinal de Liberdade-uma expressão de sentimento-

Blog Coletivo-Uma Interação de Amigos-

Meus Mimos-E SEUS PRESENTES-

SANDRA

Where To Buy Converse High Heels

On Thursday April 1 all go to the Plaza de los Dos Congress!!



Hello friends!.
On Thursday April 1 will be an event in the Plaza de los Dos Congresos TGD-Parent organized by Argentina in commemoration of International Day of Autism Awareness.
As you know, here in Argentina, on Friday, April 2 in addition to being a holiday for Easter is celebrated Veterans Day and Memorial Falklands. Whereupon, organize something for this day is impossible. That's why we decided to move the event to this day.
To give more detail about it, I then publish the information which I received by mail through the mail TGD-PADRES:

"Friends

as you guys know on April 2, is the global day of awareness about autism, Resolution No. ° 62/139, adopted by the United Nations on December 18, 2007.

Just like that, last year, PDD PARENTS, your contribution will make the next day Thursday 1 April at the Plaza the two conferences, Callao and Rivadavia Avenue . Since the April 2 meet several things (holidays, long weekend, day Falklands, Good Friday, the anniversary of the death of dr. Alfonsin, etc)

Our proposal is from 12 pm, until 16 pm.

We will make our contribution to society to raise awareness about the disorder suffered by our children, who lead the fight so they can have access to treatments, education and a full social life. We will make a great flyer that contains a brief summary of PDD concept, its main symptoms of alarm and our demands. At 15.30 there will be a release of balloons, and then will say a few words of closure.

also be a good opportunity to gather signatures for our bill, as well as a new opportunity to meet and exchange experiences.

call on all parents, professionals, friends, media, family and neighbors in the city to participate, especially with the presence, albeit 30 minutes or 4 hours, and can cooperate in qeu, flyers, collect signatures, encouraging. also ask the diffusion of the banner attached to acquaintances, relatives, dae media communication, facebook chains, to anyone you know. diffusion that everyone can do will be valuable for everyone.

invite you to take flags or signs that identify us, they can download from the following link

http://www.tgd- padres.com. ar / diffusion. Htm

invite and ask for this via our referring to the same April 1 may be made manifest of this kind in each of the provinces.

remember, and particularly the new sucriptos from the list of all the country you can contact our references for each province in the following link

http://www.tgd- padres.com. ar / contact. Htm

although an awareness day, is also a holiday!

expect them.

SUSPEND OR NO RAIN, NO NOTHING. "


also attached the press release they sent for distribution in any field, especially those who have access to media.
Personally, I took some copies to take to the garden of my son to be distributed, as well as neighboring businesses. Here it is:

Press Release April 1, 2010

So April 1 Plaza de los Dos Congresos: GOING BEYOND!

I'll be there, taking advantage of Valencia's grandparents do not work that day. In this way everyone wins, because I'm going quiet and he has blast with her grandparents, who aware of everything ... best, no?
So to all those mothers of Argentina that could go would be nice if we can find there on this special day. Hopefully we can organize ourselves so that you can give!. My email is posted on my blogger profiled, as well as contact the little sign in the right column Facebook blog. Anything write me and see how we can arrange to meet.

are waiting!