Browsing by Author "Akouri-Shan, LeeAnn"
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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 Predictors of internalized mental health stigma in a help-seeking sample of youth: The roles of psychosis-spectrum symptoms and family functioning(APA, 2022-08-01) DeLuca, Joseph; Akouri-Shan, LeeAnn; Jay, Samantha; Redman, Samantha; Petti, Emily; Lucksted, Alicia; Rouhakhtar, Pamela Rakhshan; Klaunig, Mallory; Edwards, Sarah M.; Reeves, Gloria M.; Schiffman, JasonBackground: Experiencing psychosis-spectrum symptoms is challenging to youth. Among many difficulties, internalized mental health stigma—the internalization of negative stereotypes—can lead to shame and withdrawal. The objective of this study was to better understand the correlates of internalized stigma among a clinical sample of youth with psychosis-spectrum symptoms. Method: Participants (n=66; 12-25-years-old) were referred by community providers in Maryland, United States. Psychosis-spectrum symptoms were measured via the Structured Interview for Psychosis-Risk Syndromes (SIPS); family-functioning was measured via the Family Assessment Device. Interviewers rated participants’ social/role functioning via the Global Functioning: Social and Role Scales. Internalized stigma was measured using the Internalized Stigma of Mental Illness (ISMI) total scale and subscales. Results: The sample included 34 individuals at clinical high risk for psychosis, 16 experiencing early psychosis, and 16 help-seeking controls. Regression analyses indicated that unusual beliefs, avolition, role functioning, and lower family-functioning (caregiver-reported) were significantly associated with higher aspects of internalized stigma, controlling for other symptoms and sociodemographics. These models explained 27% of the variance (adjusted R2) in the total ISMI scale and between 15%-49% of the variance in ISMI-subscales. Conclusions: Among this help-seeking sample, unusual beliefs, avolition, higher role functioning, and lower family-functioning (caregiver-reported) were associated with more internalized stigma. Pending future research with larger samples, therapeutic interventions focused on these factors and their correlates may benefit youth. Future research is needed to determine temporal precedence of these associations.Item Psychosis-like experiences and resilience: A systematic and critical review of the literature(APA, 2023-04-28) DeLuca, Joseph S.; Rouhakhtar, Pamela Rakhshan; Klaunig, Mallory; Akouri-Shan, LeeAnn; Jay, Samantha; Todd, Therese L.; Sarac, Cansu; Andorko, Nicole D.; Herrera, Shaynna N.; Dobbs, Matthew F.; Bilgrami, Zarina R.; Kline, Emily; Brodsky, Anne; Jespersen, Rachel; Landa, Yulia; Corcoran, Cheryl; Schiffman, JasonResilience research has documented the ability to cope with traumatic and stressful situations and/or retain functioning given certain risk factors in the context of psychosis. In this study, we conducted the first systematic review of the literature on psychosis-like experiences (PLEs) and resilience. Fifteen articles (from 11 unique study samples) from ten countries were included in this systematic review, with a total of 11,937 unique study participants. Inclusion criteria were broad, capturing a wide range of individuals with PLEs who have not yet experienced threshold psychosis, such as individuals in the general population with elevated self-reports of PLEs, as well as clinical groups diagnosed by clinician interviews (i.e., clinical- or ultra-high-risk for psychosis [CHR or UHR]). For this review, studies needed to include research aims and empirical research related to resilience, and use an established or author-defined measure of psychological and/or social resilience. Data reporting quality was assessed with the STROBE and PROGRESS guidelines. Study aims and measurement of key variables varied widely, and all studies were cross-sectional. In 73% of the studies, resilience was inversely associated with PLEs or psychosis risk status (e.g., CHR or UHR). Results related to specific resilience subscales were mixed. Author-defined resilience was typically related to internal/psychological resources. Future research, particularly longitudinal research involving multidimensional measurement of resilience (e.g., internal and external factors), along with well-defined theoretical models, are necessary before drawing firm conclusions on resilience and PLEs. We propose a dynamic, multifaceted, developmentally-appropriate, and culturally-sensitive model of resilience for future research.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 Review of factors resulting in systemic biases in the screening, assessment, and treatment of individuals at clinical high-risk for psychosis in the United States(Frontiers, 2023-03-13) Bridgwater, Miranda A.; Petti, Emily; Giljen, Maksim; Akouri-Shan, LeeAnn; DeLuca, Joseph; Rouhakhtar, Pamela Rakhshan; Millar, Caroline; Karcher, Nicole R.; Martin, Elizabeth A.; DeVylder, Jordan; Anglin, Deidre; Williams, Raquel; Ellman, Lauren M.; Mittal, Vijay A.; Schiffman, JasonBackground: Since its inception, research in the clinical high-risk (CHR) phase of psychosis has included identifying and exploring the impact of relevant socio-demographic factors. Employing a narrative review approach and highlighting work from the United States, sociocultural and contextual factors potentially affecting the screening, assessment, and service utilization of youth at CHR were reviewed from the current literature. Results: Existing literature suggests that contextual factors impact the predictive performance of widely used psychosis-risk screening tools and may introduce systemic bias and challenges to differential diagnosis in clinical assessment. Factors reviewed include racialized identity, discrimination, neighborhood context, trauma, immigration status, gender identity, sexual orientation, and age. Furthermore, racialized identity and traumatic experiences appear related to symptom severity and service utilization among this population. Conclusions: Collectively, a growing body of research from the United States and beyond suggests that considering context in psychosis-risk assessment can provide a more accurate appraisal of the nature of risk for psychosis, render more accurate results improving the field's prediction of conversion to psychosis, and enhance our understanding of psychosis-risk trajectories. More work is needed in the U.S. and across the globe to uncover how structural racism and systemic biases impact screening, assessment, treatment, and clinical and functional outcomes for those at CHR.Item Telepsychotherapy With Youth at Clinical High Risk for Psychosis: Clinical Issues and Best Practices During the COVID-19 Pandemic(American Psychological Association, 2020-04-22) DeLuca, Joseph S.; Andorko, Nicole D.; Chibani, Doha; Jay, Samantha Y.; Rouhakhtar, Pamela Rakhshan; Petti, Emily; Klaunig, Mallory J.; Thompson, Elizabeth C.; Millman, Zachary B.; Connors, Kathleen M.; Akouri-Shan, LeeAnn; Fitzgerald, John; Redman, Samantha L.; Roemer, Caroline; Bridgwater, Miranda A.; DeVylder, Jordan E.; King, Cheryl A.; Pitts, Steven C.; Reinblatt, Shauna P.; Wehring, Heidi J.; Bussell, Kristin L.; Solomon, Natalee; Edwards, Sarah M.; Reeves, Gloria M.; Buchanan, Robert W.; Schiffman, Jason