Thread by @Mental_Elf

Our next speaker in this session is Jean Addington (not on Twitter) from the University of Calgary in Canada @UCalgaryMed who will be talking about the North American Prodrome Longitudinal Study (NAPLS), a project in which she is one of the principal investigators #IEPA12

Addington is interested in early detection & intervention in psychosis. Currently her major research focus is the examination of predictors of conversion to psychosis & the development of psychosocial interventions for those at clinical high risk of developing psychosis #IEPA12

The North American Prodrome Longitudinal Study (NAPLS), focuses on youth at high risk of psychosis. This talk will focus on psychosis-risk syndromes, which are identified by the structured interview for psychosis-risk syndromes (SIPS) #IEPA12

The NAPLS consortium (using a common platform for electronic data) was initiated in 2003 (NAPLS-1) with 8 independently @NIMHgov funded sites, including Yale, Calgary, North Carolina, Emory, Harvard, and the University of California at San Diego & LA #IEPA12

In 2008, a 5-year @NIMHgov grant helped them incorporate biological assessment (neuroimaging, electrophysiological, hormonal, genetic) into a multi-site prospective study of 720 participants at CHR for developing psychosis & 240 matched controls, known as NAPLS-2 #IEPA12

They aimed to develop a clinical risk prediction algorithm in a new prospective sample. Each of the 8 geographical sites focused on different assessments (e.e. psychopathology, social functioning, neurocognition, imaging, genetics, treatment etc.) #IEPA12

Most common syndrome was attenuated psychotic syndrome. Most common symptom was unusual thought content. Clinical findings included: being highly symptomatic, persistent negative symptoms, comorbid diagnoses (depression & anxiety), increased early trauma (e.g. bullying) #IEPA12

An Individualized Risk Calculator for Research in Prodromal Psychosis
-verbal memory
-stressful life events
-traumatic events
-unusual thoughts
-decline in social functioning
-family history of psychosis
#IEPA12
ajp.psychiatryonline.org/doi/10.1176/ap…

Biomarker evidence was gained from imaging data (steeper rate of grey matter loss, greater rate of expansion of third ventricle, changes in thalamic connectivity, rate of cortical thinning associated with proinflammatory cytokines at baseline) #IEPA12

74 NAPLS papers had been published up to this point, but “mechanisms driving transition to psychosis were still somewhat elusive" says Jean Addington in her #IEPA12 keynote talk

Renewed funding in 2014 (NAPLS-3) started work on further clarifying the roles of neuroinflammation and deficient synaptic plasticity in the development of psychosis and a 9th site, the University of California, San Francisco was added #IEPA12

NAPLS-3 aimed to recruit a different sample w increased likelihood of transition. Biomarker & clinical assessment took place every 2m during first 8m of participation. 560 participants in total & 60 people in this group made the transition to psychosis. Analysis underway #IEPA12

Clinical heterogeneity in clinical high risk
-Range of comorbid diagnoses
-Poor functioning
-Negative symptoms
-Neurocognitive difficulties
-Same heterogeneity in outcome trajectories
#IEPA12

We need to consider the majority of people who DO NOT make the transition to psychosis, says Addington.

3 main groups:
1. In remission from APS (attenuated psychotic symptoms)
2. Symptomatic
3. Increase in symptom severity
#IEPA12

Comparison of non-transitioning groups:
-poorer social functioning and poorer cognition than healthy controls
-CHR participants are heterogeneous group and have heterogeneously longitudinal trajectories #IEPA12

Addington, 2018
doi.org/10.1017/s00332…

PRONET Psychosis Risk Outcome Network
-test whether data driven variation/biomarkers can be used to predict individual trajectories & select individual pts likely to benefit from specific rx
-27 international sites, >1,000 pts
-aim to characterise phenotypes assoc w CHR
#IEPA12

Prof Jean Addington from @UCalgaryMed is the proud recipient of the @IEPAnetwork Richard Wyatt Award for 2020 #IEPA12
iepa.org.au/award-news/ric…