Kristen Woodberry
Maine Medical Center, Maine Health Institute of Research, Faculty Member
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Tufts University School of Medicine, Psychiatry, Faculty Member add
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Background: Although the first two years of a psychotic disorder are a period of particularly high risk, it takes an average of 1.5 years for young people to start treatment following the onset of psychotic symptoms. Screening for... more
Background: Although the first two years of a psychotic disorder are a period of particularly high risk, it takes an average of 1.5 years for young people to start treatment following the onset of psychotic symptoms. Screening for psychosis in primary care may help to close this treatment gap, but there is debate on whether or not to screen all youth. Opponents argue that the risks posed to false positives are too high, and no age-appropriate psychosis screens have been developed for this population. The current study pilot tested questions for an adolescent psychosis screen and compares its overlap with the Patient Health Questionnaire (PHQ-9), a depression screen commonly given in primary care settings. Methods: The Screening for Early & Emerging Mental Experiences (SEE-ME) screen is a 23-item scale assessing recent psychotic-like experiences. It queries all major symptom domains of psychosis at a 6th grade reading level, as well as frequency and distress of these symptoms. Recruitment of youth ages 14-21 is ongoing in an adolescent primary care clinic at Boston Children’s Hospital. An independent 2-tailed t test examined the relationship between distress on SEE-ME and PHQ-9 scores that would and would not be flagged for mental health follow-up. An ANOVA examined the relationship between distress and history of mental health treatment. Results: Positive responses to SEE-ME questions were fairly common, with 32% endorsing 5 or more items. PHQ-9 and SEE-ME distress scores were closely related, with those who would be flagged for mental health follow-up showing significantly higher distress on SEE-ME (t = -5.3, df = 10.4, p\u3c0.001). However, some psychosis-spectrum items (ex. paranoia) were less commonly endorsed by those with high PHQ-9 scores. We found no significant relationship between engagement in therapy and SEE-ME distress (F=2.62, p=0.11). Conclusions: Though uncommon, there is a subset of youth for whom their psychotic-like experiences are distressing and untreated. Patients at risk for psychosis who do not have depression-like symptoms may not be flagged by the PHQ-9 or other existing screens. This key population is likely to benefit from screening
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Background: The relationship between sleep and psychosis is well-established, with sleep disturbances being one of the earliest signs of an emerging psychotic disorder. Those at clinical high-risk (CHR) for psychosis are known to... more
Background: The relationship between sleep and psychosis is well-established, with sleep disturbances being one of the earliest signs of an emerging psychotic disorder. Those at clinical high-risk (CHR) for psychosis are known to experience more fragmented sleep, which in turn increases the severity of psychotic and mood symptoms. Experience sampling is a useful method through which to understand the relationship between sleep and daily fluctuations in mood and psychosis. A better understanding of these within-day symptom dynamics may clarify the role of sleep in clinical trajectories for at-risk youth. Thus, this study used a phone app to capture real-time symptom changes alongside Fitbit & self-reported sleep monitoring to characterize symptom dynamics in early & emerging psychosis. Methods: 34 adolescents at CHR or in the early stages of a psychotic disorder completed daily surveys about their mood & experiences. Using experience sampling methods, participants received 6 semi-random surveys each day over the course of 3 weeks via a mobile phone app and wore a Fitbit to measure activity & sleep. Sleep duration and quality were calculated for all participants and compared against data from healthy controls (n=15). Moment-to-moment changes in mood were also calculated for all participants and compared across diagnostic groups. Multi-level linear and logistic regressions of affect variability and psychosis were conducted to demonstrate the effect of sleep on these symptoms. Results: We report results within and across diagnostic groups on sleep, affect variability, and psychotic symptoms. Psychosis-spectrum individuals were more likely to report poorer sleep quality (F= 3.57, p=0.04) and less time asleep (F=4.86, p=0.01) than controls. Poorer sleep quality was moderately correlated with negative affect (r=-0.40). Conclusions: Experience sampling via mobile phone apps is a uniquely effective method to monitor sleep as it relates to moment-to-moment symptom changes among those with early and emerging psychosis. These data may better characterize the role of sleep in early psychosis and present sleep as a potential treatment target to improve clinical trajectories
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Psychology, Psychiatry, Psychosis, Mood, Affect, and 3 moreSleep, Mental Disorders, and Psychotic Disorders
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Purpose: Although there is recent skepticism about whether affect dynamics offer added value over mean levels of negative affect in differentiating between individuals, there has been little research examining the relationship of affect... more
Purpose: Although there is recent skepticism about whether affect dynamics offer added value over mean levels of negative affect in differentiating between individuals, there has been little research examining the relationship of affect variability (AV) and psychotic symptoms within individuals (day-to-day). The purpose of these analyses was to explore the relationship of affect dynamics to psychotic experiences in individuals at clinical high risk (CHR) for psychosis or within five years of the onset of a psychotic disorder (PSY). Methods: We collected experience-sampling data from CHR and PSY patients ages 15-25. Up to 6 times per day, participants rated positive and negative emotions and attenuated psychotic symptoms (PS) on a 7-point Likert scale from “Not at all” to “Very much”. AV was calculated with moment-to-moment mean squared successive differences (MSSD). We conducted multilevel linear regression to test the relationship of AV and PS averaged at the daily level. Results: Preliminary analyses (n = 27, 13 male, m age = 19.9, sd = 2.4) suggest that daily negative AV is significantly associated with mean daily PS, even controlling for same day mean negative AV and PS on the previous day. Negative AV measured at the person level is associated with anxiety and bipolar disorder but not depressive or psychotic diagnoses. Conclusions: Affect dynamics may offer incremental value over mean affect levels in understanding symptom trajectories during the early phases of psychotic disorders. We will present analyses of a larger sample and additional assessments of symptom dynamics
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Early identification and intervention is a gold standard for psychotic disorders, for which delays in care can have serious consequences. Screening for psychosis in primary care may circumvent barriers related to stigma and facilitate... more
Early identification and intervention is a gold standard for psychotic disorders, for which delays in care can have serious consequences. Screening for psychosis in primary care may circumvent barriers related to stigma and facilitate shorter pathways to care. Yet, there is debate regarding the benefit-risk balance for psychosis screening in general adolescent populations. Primary care patients of an adolescent/young adult medical clinic in the US ages 14-21 self-administered surveys assessing age, sex, receipt of psychotherapy, and occurrence, frequency (1-5), and distress (0-3) for 23 psychosis risk (PR) symptoms, including 6 general/nonspecific items and 17 psychosis-specific items. Participants also completed the 9-item Patient Health Questionnaire (PHQ-9); scores of ≥10 suggested clinically significant depressive symptoms. Analyses characterized PR symptoms and examined associations of PR symptom distress with current therapy and depressive symptom severity. Of 212 patients who completed the survey, 75% endorsed ≥1 PR symptom and 27% rated ≥3 on distress for psychosis-specific items. Those with high PHQ-9 scores reported higher PR distress overall (t = -6.1, df = 52.3, p < 0.001) but not on psychosis-specific items such as hallucinations and suspiciousness. One in 9 participants reported heightened PR distress without being in therapy or having high depressive symptoms. Most adolescents in this primary care sample endorsed symptoms associated with PR. Distress related to these symptoms was less common but occurred even in the absence of depressive symptoms. PR screening only in youth with high depressive symptom screens or in mental health care may miss youth needing further assessment for psychosis.
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AIM Successful delivery of care to individuals with early psychosis depends on the ability of community providers to identify and refer appropriate candidates for services. Although specialty centres commonly rely upon education and... more
AIM Successful delivery of care to individuals with early psychosis depends on the ability of community providers to identify and refer appropriate candidates for services. Although specialty centres commonly rely upon education and outreach campaigns to building bridges with community providers, few studies have examined the effectiveness of these campaigns or the mechanisms by which they may achieve their intended effects. METHODS We surveyed community clinicians (N = 39) about their screening behaviours, referral practices, and confidence in managing early psychosis just before and 3-6 months after attending an educational event designed to promote recognition and quality treatment of early psychosis. RESULTS Three to six months following attendance, providers reported screening a greater proportion of clients for early psychosis, referring a greater number of clients to specialty services, and feeling more confident in their ability to respond to clients with early psychosis. Increases in confidence following attendance were associated with corresponding increases in screening behaviour. CONCLUSIONS The results suggest that outreach campaigns designed to enhance community providers' knowledge about early psychosis assessment and resources may be effective in promoting screening, referrals, and confidence in managing psychosis. Gains in provider confidence may contribute to increases in screening. Given the lack of control group and relatively short follow-up period, more research is needed to determine the effects of early psychosis educational events and the mechanisms by which they may promote successful treatment delivery for young people in need.
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Psychology, Psychosis, Adolescent, Medicine, Neurocognitive, and 15 moreHumans, Female, Male, North America, Middle Aged, Longitudinal Studies, Adult, Disease Progression, Psychotic Disorders, Predictive value of tests, Case Control Studies, Prodromal Symptoms, Neuropsychological Tests, prodrome, and Neurocognitive disorders
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Psychology, Psychosis, Schizophrenia, Cognition, Adolescent, and 15 moreHumans, Child, Female, Male, Child and Adolescent Psychology, Adolescents, Psychological Tests, Longitudinal Studies, Age Factors, Psychotic Disorders, Reference Values, Cohort Studies, healthy controls, Psychology and Cognitive Sciences, and Medical and Health Sciences
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BackgroundOnly 30% or fewer of individuals at clinical high risk (CHR) convert to full psychosis within 2 years. Efforts are thus underway to refine risk identification strategies to increase their predictive power. Our objective was to... more
BackgroundOnly 30% or fewer of individuals at clinical high risk (CHR) convert to full psychosis within 2 years. Efforts are thus underway to refine risk identification strategies to increase their predictive power. Our objective was to develop and validate the predictive accuracy and individualized risk components of a mobile app-based psychosis risk calculator (RC) in a CHR sample from the SHARP (ShangHai At Risk for Psychosis) program.MethodIn total, 400 CHR individuals were identified by the Chinese version of the Structured Interview for Prodromal Syndromes. In the first phase of 300 CHR individuals, 196 subjects (65.3%) who completed neurocognitive assessments and had at least a 2-year follow-up assessment were included in the construction of an RC for psychosis. In the second phase of the SHARP sample of 100 subjects, 93 with data integrity were included to validate the performance of the SHARP-RC.ResultsThe SHARP-RC showed good discrimination of subsequent transition to psyc...
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Chinese psychiatrists have gradually started to focus on those who are deemed to be at 'clinical high-risk (CHR)' for psychosis; however, it is still unknown how often those individuals identified as CHR from a different country... more
Chinese psychiatrists have gradually started to focus on those who are deemed to be at 'clinical high-risk (CHR)' for psychosis; however, it is still unknown how often those individuals identified as CHR from a different country background than previously studied would transition to psychosis. The objectives of this study are to examine baseline characteristics and the timing of symptom onset, help-seeking, or transition to psychosis over a 2-year period in China. The presence of CHR was determined with the Structured Interview for Prodromal Syndromes (SIPS) at the participants' first visit to the mental health services. A total of 86 (of 117) CHR participants completed the clinical follow-up of at least 2 years (73.5%). Conversion was determined using the criteria of presence of psychotic symptoms (in SIPS). Analyses examined baseline demographic and clinical predictors of psychosis and trajectory of symptoms over time. Survival analysis (Kaplan-Meier) methods along wit...
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Early intervention in serious mental health conditions relies on the accurate identification of adolescents and young adults at high risk or with very recent onset of psychosis. Current early detection strategies have had limited success,... more
Early intervention in serious mental health conditions relies on the accurate identification of adolescents and young adults at high risk or with very recent onset of psychosis. Current early detection strategies have had limited success, identifying only a fraction of these individuals within the recommended 3- to 6-month window. Broader public health strategies such as population screening are hampered by low base rates and poor self-report screen specificity. Screening for Early Emerging Mental Experiences (SEE ME) is a three-stage “SCREEN—TRIAGE—ENGAGE” model for the early detection of psychosis in integrated primary care adolescent and young adult patients during the period of peak onset. It builds on the KNOW THE SIGNS—FIND THE WORDS—MAKE THE CONNECTION framework outlined on psychosisscreening.org and developed with input from community collaborators. Systematic screening aims to expand the reach of early detection and reduce reliance on provider knowledge. Triage and engageme...
Purpose/Background: There is a large amount of literature exploring how individuals with psychotic spectrum symptoms or disorders experience empathy. The findings are often presented through a deficit-oriented frame, suggesting that these... more
Purpose/Background: There is a large amount of literature exploring how individuals with psychotic spectrum symptoms or disorders experience empathy. The findings are often presented through a deficit-oriented frame, suggesting that these individuals are impaired in their ability to experience empathy. Unfortunately, claims of empathy deficits have the potential to contribute to the already high stigma faced by this population. This review, therefore, aims to contextualize the deficit-oriented discussion based on the following three questions: how is empathy defined, what methods are being used to understand it, and to what degree does the discussion around empathy in psychosis accurately reflect findings. Methods/Approach: I will perform a conceptual survey of the literature discussing research on empathy in psychotic spectrum disorders, including schizophrenia, first episode psychosis, affective psychosis, and individuals with attenuated psychotic symptoms. I will organize finding...
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Supplemental material, Supplemental_data-1 for Clinical subtypes that predict conversion to psychosis: A canonical correlation analysis study from the ShangHai At Risk for Psychosis program by TianHong Zhang, XiaoChen Tang, HuiJun Li,... more
Supplemental material, Supplemental_data-1 for Clinical subtypes that predict conversion to psychosis: A canonical correlation analysis study from the ShangHai At Risk for Psychosis program by TianHong Zhang, XiaoChen Tang, HuiJun Li, Kristen A Woodberry, Emily R Kline, LiHua Xu, HuiRu Cui, YingYing Tang, YanYan Wei, ChunBo Li, Li Hui, Margaret A Niznikiewicz, Martha E Shenton, Matcheri S Keshavan, William S Stone and JiJun Wang in Australian & New Zealand Journal of Psychiatry
Summary: Research diagnostic instruments such as the Structured Interview for Prodromal Syndromes (SIPS) are now able to reliably identify individuals with different types of psychosis risk syndromes (PRS). About one-third of individuals... more
Summary: Research diagnostic instruments such as the Structured Interview for Prodromal Syndromes (SIPS) are now able to reliably identify individuals with different types of psychosis risk syndromes (PRS). About one-third of individuals with PRS convert to a diagnosable psychotic disorder within three years of the initial assessment. Currently available randomized controlled trials of interventions aimed at reducing the rate of psychotic conversion of PRS are promising, but they are too small and too short in duration to provide definitive conclusions about effectiveness. Given the high level of false positives (i.e., most individuals with PRS do not progress to frank psychosis) and the lack of definitive evidence about effectiveness, we recommend a staged approach to intervention in PRS that only uses antipsychotic medication after other, more benign approaches have been tried. At present the best approach appears to be to develop high-quality case-management systems for individua...
OBJECTIVE Despite the appeal of early intervention in psychosis, there is concern that identifying youth as having high psychosis risk (PR) may trigger stigma. This study employed a pre-post design to measure change in PR... more
OBJECTIVE Despite the appeal of early intervention in psychosis, there is concern that identifying youth as having high psychosis risk (PR) may trigger stigma. This study employed a pre-post design to measure change in PR participants' emotions about PR upon being told of their PR status and according to whether this was the first time receiving this information. METHODS Participants (n = 54) identified as at PR via structured interview rated their emotions about PR before and after being told they were at PR. Qualitative analyses explored the valence of participant reflections on being given this information. RESULTS Participants reported significantly less negative emotion after being told of their PR status (p < .001), regardless of whether they were hearing this for the first time (p = .72). There was no change in positive emotions or the predominant belief that they should keep their PR status private. Most participants commented positively about the process of feedback but negatively about its impact on their self-perceptions and/or expectations of others' perceptions of them. CONCLUSION This is the first study to collect pre-post data related to being told one is at PR and to examine quantitative and qualitative responses across and within individuals. For a majority of participants, clinical feedback stimulated negative stereotypes even as it relieved some distress. To actively address internalized stigma, clinicians providing feedback to PR youth must attend to the positive and negative impacts on how youth think about themselves as well as how they feel.
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We previously reported abnormal P300 and N200 in a visual oddball task, and progressive P300 amplitude reduction at 1‐year follow‐up in patients with first‐episode schizophrenia. P300 reduction as well as intact P1/N1 were also observed... more
We previously reported abnormal P300 and N200 in a visual oddball task, and progressive P300 amplitude reduction at 1‐year follow‐up in patients with first‐episode schizophrenia. P300 reduction as well as intact P1/N1 were also observed in clinical high‐risk subjects (CHR), but whether or not these components change over time is unknown. This study evaluates, longitudinally, the visual P300, as well as P1, N1, and N200, in CHR.
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The peak onset of psychotic disorders occurs during adolescence and early adulthood, yet treatments for youth at clinical high risk (CHR) for psychosis are generally designed for adults. CHR youth, despite poor academic and social... more
The peak onset of psychotic disorders occurs during adolescence and early adulthood, yet treatments for youth at clinical high risk (CHR) for psychosis are generally designed for adults. CHR youth, despite poor academic and social engagement, spend hours each day playing complicated videogames. The aim of this study was to test the feasibility of integrating biofeedback and cooperative videogame play within family therapy as a means of engaging and enhancing this population's resilience.
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The early auditory-evoked gamma band response (EAGBR) may serve as an index of the integrity of fast recurrent inhibition or synaptic connectivity in the auditory cortex, where abnormalities in individuals with schizophrenia have been... more
The early auditory-evoked gamma band response (EAGBR) may serve as an index of the integrity of fast recurrent inhibition or synaptic connectivity in the auditory cortex, where abnormalities in individuals with schizophrenia have been consistently found. The EAGBR has been rarely investigated in first episode schizophrenia patients (FESZ) and individuals at clinical high risk (CHR) for schizophrenia, and never been compared directly between these populations nor evaluated longitudinally. Here we examined the EAGBR in FESZ, CHR, and matched healthy controls (HC) at baseline and 1-year follow-up assessments to determine whether the EAGBR was affected in these clinical groups, and whether any EAGBR abnormalities changed over time. The electroencephalogram was recorded with a dense electrode array while subjects (18 FESZ, 18 CHR, and 40 HC) performed an auditory oddball task. Event-related spectral measures (phase locking factor [PLF] and evoked power) were computed on Morlet-wavelet-transformed single epochs from the standard trials. At baseline, EAGBR PLF and evoked power did not differ between groups. FESZ showed progressive reductions of PLF and evoked power from baseline to follow-up, and deficits in PLF at follow-up compared to HC. EAGBR peak frequency also increased at temporal sites in FESZ from baseline to follow-up. Longitudinal effects on the EAGBR were not found in CHR or HC, nor did these groups differ at follow-up. In conclusion, we detected neurophysiological changes of auditory cortex function in FESZ during a one-year period, which were not observed in CHR. These findings are discussed within the context of neurodevelopmental models of schizophrenia.
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Schizophrenia is a highly stigmatized disorder. Identification of youth at high risk for psychosis has the potential for improved outcomes. However, identifying youth at risk could subject them to increased public stigma. Using an... more
Schizophrenia is a highly stigmatized disorder. Identification of youth at high risk for psychosis has the potential for improved outcomes. However, identifying youth at risk could subject them to increased public stigma. Using an experimental vignette design, this study examined relative levels of public stigma elicited by the labels "schizophrenia," "clinical high risk (CHR)," "attenuated psychotic symptoms syndrome (APSS)," a label implying normative adolescent development ("a bad breakup"), and a no-label control condition. Ninety-six undergraduates (age: 18.8 + 1.1, range: 18-22) read a vignette describing an adolescent experiencing symptoms typical of CHR for psychosis. The vignette label (APSS, CHR, schizophrenia, a bad breakup or no label) was counterbalanced between participants. Participants answered questions assessing stigma toward the individual and their prior knowledge of and familiarity with psychosis. Overall stigma did not di...
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Schizophrenia spectrum disorders (SSDs) are among the most serious and complicated psychiatric disorders, particularly in children and adolescents. They have a major impact on all aspects of functioning, including family and social... more
Schizophrenia spectrum disorders (SSDs) are among the most serious and complicated psychiatric disorders, particularly in children and adolescents. They have a major impact on all aspects of functioning, including family and social relationships, school, work, and self-care. While schizophrenia tends to develop in late adolescence and early adulthood, nonspecific abnormalities, prodromal symptoms, and a significant proportion of its incidence unfold before age 18. It behooves child and adolescent clinicians to be knowledgeable about and alert to the range of SSD clinical presentations. The chapter reviews the current state of the literature regarding the phenomenology, epidemiology, assessment, diagnosis, and treatment of SSD within a developmental and systems framework. Although both evidence-based and promising practices are presented, these are all too often drawn from the adult literature, underscoring the pressing need for progress in developmentally sensitive assessment and tr...
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Depressed mood appears to be highly prevalent in clinical high risk (CHR) samples. However, many prior CHR studies utilize modest size samples and do not report on the specific impact of depression on CHR symptoms. The aim of the current... more
Depressed mood appears to be highly prevalent in clinical high risk (CHR) samples. However, many prior CHR studies utilize modest size samples and do not report on the specific impact of depression on CHR symptoms. The aim of the current paper is to investigate the prevalence of depressive disorders and the impact of lifetime depression on baseline clinical presentation and longitudinal outcomes in a large cohort of individuals meeting CHR criteria in the second phase of the North American Prodrome Longitudinal Study (NAPLS-2). Depression was assessed both categorically (via DSM-IV-TR diagnoses) and symptomatically (using a clinician-rated scale of depressive symptoms) within a sample of 764 individuals at CHR and 279 controls. Current and lifetime depressive disorders were highly prevalent (60%) in this sample. Depression diagnoses were associated with more pronounced negative and general symptoms; individuals with remitted depression had significantly less severe negative, disorga...