Ashlee B Grierson1, Jan Scott1,2, Nick Glozier1, Ian B Hickie1, Paul G Amminger3,4, Eoin Killackey3,4, Patrick D McGorry3,4, Christos Pantelis5, Lisa Phillips6, Elizabeth Scott1,7, Alison R Yung8,9, Rosemary Purcell3,4. 1. Brain and Mind Research Institute, The University of Sydney, Sydney, New South Wales, Australia. 2. Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK. 3. Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia. 4. Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia. 5. Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Carlton South, Victoria, Australia. 6. Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia. 7. School of Medicine, Notre Dame University, Sydney, New South Wales, Australia. 8. Division of Psychology and Mental Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK. 9. Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK.
Abstract
AIM: Clinical staging models offer a useful framework for understanding illness trajectories, where individuals are located on a continuum of illness progression from stage 0 (at-risk but asymptomatic) to stage 4 (end-stage disease). Importantly, clinical staging allows investigation of risk factors for illness progression with the potential to target trans-diagnostic mechanisms at an early stage, especially in help-seeking youth who often present with sub-threshold syndromes. While depressive symptoms, rumination and sleep-wake disturbances may worsen syndrome outcomes, the role of these related phenomena has yet to be examined as risk factors for trans-diagnostic illness progression in at-risk youth. METHODS: This study is a prospective follow-up of 248 individuals aged 12 to 25 years presenting to headspace services with sub-threshold syndromes (stage 1) classified under the clinical staging model to determine transition to threshold syndromes (stage 2). Factor analysis of depression, rumination and sleep-wake patterns was used to identify key dimensions and any associations between factors and transition to stage 2 at follow-up. RESULTS: At 1 year, 9% of cases met criteria for stage 2 (n = 22). One of three identified factors, namely the factor reflecting the commonalities shared between rumination and sleep-wake disturbance, significantly differentiated cases that transitioned to stage 2 vs those that did not demonstrate transition. Items loading onto this factor, labelled Anergia, included depression severity and aspects of rumination and sleep-wake disturbance that were characterized as introceptive. CONCLUSIONS: Common dimensions between rumination and sleep-wake disturbance present a detectable trans-diagnostic marker of illness progression in youth, and may represent a target for early intervention.
AIM: Clinical staging models offer a useful framework for understanding illness trajectories, where individuals are located on a continuum of illness progression from stage 0 (at-risk but asymptomatic) to stage 4 (end-stage disease). Importantly, clinical staging allows investigation of risk factors for illness progression with the potential to target trans-diagnostic mechanisms at an early stage, especially in help-seeking youth who often present with sub-threshold syndromes. While depressive symptoms, rumination and sleep-wake disturbances may worsen syndrome outcomes, the role of these related phenomena has yet to be examined as risk factors for trans-diagnostic illness progression in at-risk youth. METHODS: This study is a prospective follow-up of 248 individuals aged 12 to 25 years presenting to headspace services with sub-threshold syndromes (stage 1) classified under the clinical staging model to determine transition to threshold syndromes (stage 2). Factor analysis of depression, rumination and sleep-wake patterns was used to identify key dimensions and any associations between factors and transition to stage 2 at follow-up. RESULTS: At 1 year, 9% of cases met criteria for stage 2 (n = 22). One of three identified factors, namely the factor reflecting the commonalities shared between rumination and sleep-wake disturbance, significantly differentiated cases that transitioned to stage 2 vs those that did not demonstrate transition. Items loading onto this factor, labelled Anergia, included depression severity and aspects of rumination and sleep-wake disturbance that were characterized as introceptive. CONCLUSIONS: Common dimensions between rumination and sleep-wake disturbance present a detectable trans-diagnostic marker of illness progression in youth, and may represent a target for early intervention.
Authors: Michael J McCarthy; John F Gottlieb; Robert Gonzalez; Colleen A McClung; Lauren B Alloy; Sean Cain; Davide Dulcis; Bruno Etain; Benicio N Frey; Corrado Garbazza; Kyle D Ketchesin; Dominic Landgraf; Heon-Jeong Lee; Cynthia Marie-Claire; Robin Nusslock; Alessandra Porcu; Richard Porter; Philipp Ritter; Jan Scott; Daniel Smith; Holly A Swartz; Greg Murray Journal: Bipolar Disord Date: 2021-12-10 Impact factor: 5.345
Authors: Ralph Kupka; Anne Duffy; Jan Scott; Jorge Almeida; Vicent Balanzá-Martínez; Boris Birmaher; David J Bond; Elisa Brietzke; Ines Chendo; Benicio N Frey; Iria Grande; Danella Hafeman; Tomas Hajek; Manon Hillegers; Marcia Kauer-Sant'Anna; Rodrigo B Mansur; Afra van der Markt; Robert Post; Mauricio Tohen; Hailey Tremain; Gustavo Vazquez; Eduard Vieta; Lakshmi N Yatham; Michael Berk; Martin Alda; Flávio Kapczinski Journal: Bipolar Disord Date: 2021-07-23 Impact factor: 5.345