Browsing by Author "Demro, Caroline"
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Item The association between sleep dysfunction and psychosis-like experiences among college students(Elsevier B.V, 2017-02) Andorko, Nicole D.; Mittal, Vijay; Thompson, Elizabeth; Denenny, Danielle; Epstein, Gregory; Demro, Caroline; Wilson, Camille; Sun, Shuyan; Klingaman, Elizabeth A.; DeVylder, Jordan; Oh, Hans; Postolache, Teodor T.; Reeves, Gloria M.; Schiffman, JasonSleep problems are prominent and pervasive clinical issues experienced by many people with psychotic disorders, often causing distress and functional impairment. Sleep problems are also related to psychosis-like experiences (PLE; non-diagnosable phenomenon such as transient perceptual disturbances, unusual thoughts, periodic suspiciousness) in epidemiological studies. Prior studies in this field have used brief measures that precluded the ability to test (1) whether risk for psychosis-like experiences are related to specific sub-types of sleep disturbance, and (2) whether sleep disturbance is specifically related to clinically significant (i.e., distressing) psychosis-like experiences. The current project examined the relation between specific sleep issues, and PLEs and distress associated with PLEs, in a college sample. Participants (N=420) completed the Prodromal Questionnaire-Brief (PQ-B), which assesses PLEs and associated distress, and the Iowa Sleep Disturbances Inventory – extended version (ISDI-E), which assesses thirteen separate disturbed sleep domains. Symptoms of fragmented sleep, sleep hallucinations, and night anxiety significantly correlated with PLEs, and several sleep domains were significantly associated with PLE-related distress.Item Attitudes towards cannabis use and genetic testing for schizophrenia(Wiley Online Library, 2014-06-23) Schiffman, Jason; Lawrence, Ryan E.; Demro, Caroline; Appelbaum, Paul S.; Dixon, Lisa B.Aim Within schizophrenia, genetic factors contribute greatly to risk, yet genetic testing for the disorder is not available. For some individuals with specific genotypes, cannabis use may increase risk of schizophrenia. It is possible that genetic tests could be offered in the future to inform individuals of the risk of schizophrenia if they use cannabis. Previous research, however, provides little guidance on how young adults might respond to such tests. Methods We assessed a group of young adults (n = 83) to determine how the perceived magnitude of increased risk for schizophrenia in the presence of cannabis use influences decisions to undergo genetic testing, as well as subsequent attitudes and intentions towards cannabis use. Results Participants were significantly more likely to indicate willingness to get tested if the results identified a 10% risk versus a 2% risk of schizophrenia. Participants also indicated that if the results of their test reflected increased risk due to cannabis use, it would be more important to avoid cannabis in the 10% risk scenario as compared to the 2% risk scenario. These findings remained consistent among a subset of participants who indicated cannabis use. Conclusions Results suggest that cannabis users and non‐users were positively influenced in terms of intentions to change behaviour based on the magnitude of risk conveyed by genetic testing. These findings provide an initial step towards understanding young people's attitudes towards genetic testing and may help prepare interventions specifically tailored around cannabis use reduction for people at risk for schizophrenia.Item Evidence of reward system dysfunction in youth at clinical high-risk for psychosis from two event-related fMRI paradigms(Elsevier, 2020-12-16) Millman, Zachary B.; Gallagher, Keith; Demro, Caroline; Schiffman, Jason; Reeves, Gloria M.; Gold, James M.; Rouhakhtar, Pamela Rakhshan; Fitzgerald, John; Andorko, Nicole D.; Redman, Samantha; Buchanan, Robert W.; Rowland, Laura M.; Waltz, James A.Abnormal reward processing is thought to play an important role in the development of psychosis, but relatively few studies have examined reward prediction errors, reinforcement learning (RL), and the reward circuitry that subserves these interconnected processes among individuals at clinical high-risk (CHR) for the disorder. Here, we present behavioral and functional neuroimaging results of two experimental tasks designed to measure overlapping aspects of reward processing among individuals at CHR (n = 22) and healthy controls (n = 19). We found no group differences in response times to positive, negative, or neutral outcome-signaling cues, and no significant differences in brain activation during reward anticipation or receipt. Youth at CHR, however, displayed clear RL impairments, as well as attenuated responses to rewards and blunted prediction error signals in the ventral striatum, dorsal anterior cingulate cortex (dACC), and ventromedial prefrontal cortex (vmPFC). Greater contrasts for cue valence (gain-loss) and outcome magnitude (large-small) in the vmPFC were associated with more severe negative symptoms, and deficits in dACC signaling during RL were associated with more depressive symptoms. Our results provide evidence for RL deficits and abnormal prediction error signaling in the brain's reward circuitry among individuals at CHR, while also suggesting that reward motivation may be relatively preserved at this stage in development. Longitudinal studies, medication-free participants, and comparison of neurobehavioral measures against both healthy and clinical controls are needed to better understand the role of reward system abnormalities in the development of psychosis.Item Family functioning moderates the impact of psychosis-risk symptoms on social and role functioning(Elsevier, 2019-03-02) Thompson, Elizabeth; Rouhakhtar, Pamela Rakhshan; Pitts, Steve; Demro, Caroline; Millman, Zachary B.; Bussell, Kristin; DeVylder, Jordan; Kline, Emily; Reeves, Gloria M.; Schiffman, JasonBackground Youth at clinical high-risk (CHR) for psychosis often experience difficulties in social and role functioning. Given evidence that family stress and support can impact psychosis-risk symptoms, as well as an individual's ability to fulfill social and role functions, family dynamics are hypothesized to moderate the effect of psychosis-risk symptoms on functioning. Methods Participants at CHR (N = 52) completed the clinician-administered Structured Interview for Psychosis-risk Syndromes (SIPS) and the Family Assessment Device (FAD) General Functioning Scale, a self-report measure of family functioning including cohesion and support. Interviewers rated participants' current social and role functioning using the Global Functioning: Social and Role Scales. Results Regression results indicated that positive symptoms, but not ratings of family functioning, statistically predicted social and role functioning. Perceived family functioning, however, moderated the effect of symptoms on social/role functioning. For individuals who perceived lower levels of family functioning, symptoms were moderately associated with social and role functioning (f2 = 0.17 and f2 = 0.23, respectively). In contrast, psychosis-risk symptoms were not significantly associated with social/role functioning for individuals with higher levels of perceived family functioning. Notably, positive symptoms and perceived family functioning were not associated with one another, suggesting that perceived family functioning did not directly impact symptom severity, or vice versa. Conclusions Findings support the notion that family functioning may be a clinically meaningful factor for individuals at CHR. Although this cross-sectional data limits our discussion of potential mechanisms underlying the pattern of findings, results suggest that familial support may be beneficial for individuals at risk for psychosis.Item The impact of age on the validity of psychosis-risk screening in a sample of help-seeking youth(Elsevier B.V., 2019-04) Rouhakhtar, Pamela Rakhshan; Pitts, Steven C.; Millman, Zachary B.; Andorko, Nicole D.; Redman, Samantha; Wilson, Camille; Demro, Caroline; Phalen, Peter L.; Walsh, Barbara; Woods, Scott; Reeves, Gloria M.; Schiffman, JasonSelf-report screening instruments offer promise in furthering early identification of at-risk youth, yet current efforts are limited by false positive rates. Identifying moderators of accuracy is a potential step towards improving identification and prevention efforts. We investigated the moderating effect of age on self-reported attenuated positive symptoms from the Prime Screen and clinician diagnosed clinical high-risk/early psychosis (CHR/EP) status. Participants (N = 134) were racially diverse, lower-income, help-seeking adolescents and young adults from a primarily urban community. The overall model predicting CHR/EP status was significant, with results suggesting the presence of a trending interaction between age and Prime Screen symptoms. Analyses indicated that number of items endorsed to predict CHR/EP decreased with age (youngest group [M = 12.99] cut off = 6 items; middle age group [M = 14.97] cut off = 3; oldest age group [M = 18.40] cut off = 1). Although younger participants endorsed more risk items on average, follow up analyses suggested that the Prime Screen was a more accurate predictor of clinician-diagnosed-risk among older participants relative to their younger peers. The current study builds on the literature identifying moderators of psychosis-risk screening measure accuracy, highlighting potential limitations of CHR/EP screening tools in younger populations.Item Linking salience signaling with early adversity and affective distress in individuals at clinical high-risk for psychosis: results from an event-related fMRI study(Oxford, 2022-06-17) Millman, Zachary B.; Schiffman, Jason; Gold, James M.; Akouri-Shan, LeeAnn; Demro, Caroline; Fitzgerald, John; Rouhakhtar, Pamela Rakhshan; Klaunig, Mallory; Rowland, Laura M.; Waltz, James A.Evidence suggests dysregulation of the salience network in individuals with psychosis, but few studies have examined the intersection of stress exposure and affective distress with prediction error (PE) signals among youth at clinical high-risk (CHR). Here, 26 individuals at CHR and 19 healthy volunteers (HVs) completed a monetary incentive delay task in conjunction with fMRI. We compared these groups on the amplitudes of neural responses to surprising outcomes—PEs without respect to their valence—across the whole brain and in two regions of interest, the anterior insula and amygdala. We then examined relations of these signals to the severity of depression, anxiety, and trauma histories in the CHR group. Relative to HV, youth at CHR presented with aberrant PE-evoked activation of the temporoparietal junction and weaker deactivation of the precentral gyrus, posterior insula, and associative striatum. No between-group differences were observed in the amygdala or anterior insula. Among youth at CHR, greater trauma histories were correlated with stronger PE-evoked amygdala activation. No associations were found between affective symptoms and the neural responses to PE. Our results suggest that unvalenced PE signals may provide unique information about the neurobiology of CHR syndromes and that early adversity exposure may contribute to neurobiological heterogeneity in this group. Longitudinal studies of young people with a range of risk syndromes are needed to further disentangle the contributions of distinct aspects of salience signaling to the development of psychopathology.Item Neural biomarkers of risk for psychosis(2015-01-01) Demro, Caroline; Schiffman, Jason; Psychology; PsychologySchizophrenia is a potentially debilitating mental disorder which is usually preceded by one to two years of attenuated psychotic symptoms. The identification of individuals at psychosis-risk has relied on self-report and interview measures, which have limited specificity. Early identification could benefit from the discovery of biomarkers that may add accuracy of identification when used in conjunction with the self-report measures. Proton Magnetic Resonance Spectroscopy is an imaging technique used to quantify brain metabolites. Development of psychosis may be associated with metabolite concentration changes that reflect an alteration in glutamatergic mechanisms. Elevated glutamate levels have been observed in the striatum of individuals at psychosis-risk and individuals in their first episode of schizophrenia as compared to healthy controls. The current study explored glutamatergic metabolite concentrations in the striatal and cingulate gyri as potential biomarkers to aid in the understanding of psychosis-risk symptoms.Item Relations Among Anhedonia, Reinforcement Learning, and Global Functioning in Help-seeking Youth(Oxford University Press, 2021-07-08) Akouri-Shan, LeeAnn; Schiffman, Jason; Millman, Zachary B; Demro, Caroline; Fitzgerald, John; Rouhakhtar, Pamela Rakhshan; Redman, Samantha; Reeves, Gloria M; Chen, Shuo; Gold, James M; Martin, Elizabeth A; Corcoran, Cheryl; Roiser, Jonathan P; Buchanan, Robert W; Rowland, Laura M; Waltz, James ADysfunction in the neural circuits underlying salience signaling is implicated in symptoms of psychosis and may predict conversion to a psychotic disorder in youth at clinical high risk (CHR) for psychosis. Additionally, negative symptom severity, including consummatory and anticipatory aspects of anhedonia, may predict functional outcome in individuals with schizophrenia-spectrum disorders. However, it is unclear whether anhedonia is related to the ability to attribute incentive salience to stimuli (through reinforcement learning [RL]) and whether measures of anhedonia and RL predict functional outcome in a younger, help-seeking population. We administered the Salience Attribution Test (SAT) to 33 participants who met criteria for either CHR or a recent-onset psychotic disorder and 29 help-seeking youth with nonpsychotic disorders. In the SAT, participants must identify relevant and irrelevant stimulus dimensions and be sensitive to different reinforcement probabilities for the 2 levels of the relevant dimension (“adaptive salience”). Adaptive salience attribution was positively related to both consummatory pleasure and functioning in the full sample. Analyses also revealed an indirect effect of adaptive salience on the relation between consummatory pleasure and both role (αβ = .22, 95% CI = 0.02, 0.48) and social functioning (αβ = .14, 95% CI = 0.02, 0.30). These findings suggest a distinct pathway to poor global functioning in help-seeking youth, via impaired reward sensitivity and RL.Item Using the K-SADS psychosis screen to identify people with early psychosis or psychosis risk syndromes(Sage, 2019-05-16) Tsuji, Thomas; Phalen, Peter; Rouhakhtar, Pamela Rakhshan; Millman, Zachary; Bussell, Kristin; Thompson, Elizabeth; Demro, Caroline; Roemer, Caroline; Reeves, Gloria; Schiffman, JasonBackground: Current methods to identify people with psychosis risk involve administration of specialized tools such as the Structured Interview for Psychosis-Risk Syndromes (SIPS), but these methods have not been widely adopted. Validation of a more multipurpose assessment tool—such as the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS)—may increase the scope of identification efforts. Methods: We assessed the correspondence between SIPS-determined clinical high risk/early psychosis (CHR/early psychosis) status and K-SADS psychosis screen (child and parent reports and their combination) in a sample of 147 help-seeking individuals aged 12–25. Detailed classification results are reported. Results: Both the child and parent interviews on the K-SADS psychosis screen were strongly predictive of CHR/early psychosis status, although parent reports contributed no significant additional information beyond child reports. Across informants, the presence of either subthreshold hallucinations or subthreshold delusions was highly suggestive of CHR/early psychosis status as determined by SIPS interview (78% (child) and 74% (parent) accuracy). Conclusions: Subthreshold scores on the two-item K-SADS psychosis screen may be good indicators of the presence or absence of early signs of psychosis. The option of using a non-specialized assessment such as the K-SADS as a staged approach to assess for CHR/early psychosis status could increase rates of early psychosis screening and treatment.