Papers by Joachim Klosterkötter
Psychosocial outcome in patients at clinical high risk of psychosis: a prospective follow-up
Social Psychiatry and Psychiatric Epidemiology, 2013
In patients at clinical high risk (CHR) of psychosis, transition to psychosis has been the focus ... more In patients at clinical high risk (CHR) of psychosis, transition to psychosis has been the focus of recent studies. Their broader outcome has received less attention. We studied psychosocial state and outcome in CHR patients. In the European Prediction of Psychosis Study, 244 young help-seeking CHR patients were assessed with the Strauss and Carpenter Prognostic Scale (SCPS) at baseline, and 149 (61.1%) of them were assessed for the second time at the 18-month follow-up. The followed patients were classified into poor and good outcome groups. Female gender, ever-married/cohabitating relationship, and good working/studying situation were associated with good baseline SCPS scores. During follow-up, patients' SCPS scores improved significantly. Good follow-up SCPS scores were predicted by higher level of education, good working/studying status at baseline, and white ethnicity. One-third of the followed CHR patients had poor global outcome. Poor working/studying situation and lower level of education were associated with poor global outcome. Transition to psychosis was associated with baseline, but not with follow-up SCPS scores or with global outcome. The majority of CHR patients experience good short-term recovery, but one-third have poor psychosocial outcome. Good working situation is the major indicator of good outcome, while low level of education and non-white ethnicity seem to be associated with poor outcome. Transition to psychosis has little effect on psychosocial outcome in CHR patients. In treating CHR patients, clinicians should focus their attention on a broader outcome, and not only on preventing transition to psychosis.
Acta Psychiatrica Scandinavica, 2012
on behalf of the EPOS group. Cannabis use and age at onset of symptoms in subjects at clinical hi... more on behalf of the EPOS group. Cannabis use and age at onset of symptoms in subjects at clinical high risk for psychosis.
Acta Psychiatrica Scandinavica, 2013
on behalf of the EPOS group. The Strauss and Carpenter Prognostic Scale in subjects clinically at... more on behalf of the EPOS group. The Strauss and Carpenter Prognostic Scale in subjects clinically at high risk of psychosis.
Frontiers in psychiatry, 2013
The basic symptoms (BS) approach provides a valid instrument in predicting psychosis onset and re... more The basic symptoms (BS) approach provides a valid instrument in predicting psychosis onset and represents moreover a significant heuristic framework for research. The term "basic symptoms" denotes subtle changes of cognition and perception in the earliest and prodromal stages of psychosis development. BS are thought to correspond to disturbances of neural information processing. Following the heuristic implications of the BS approach, the present paper aims at exploring disturbances of information processing, revealed by functional magnetic resonance imaging (fMRI) and electro-encephalographic as characteristics of the at-risk state of psychosis. Furthermore, since high-risk studies employing ultra-high-risk criteria revealed non-conversion rates commonly exceeding 50%, thus warranting approaches that increase specificity, the potential contribution of neural information processing disturbances to psychosis prediction is reviewed. In summary, the at-risk state seems to be ...
P-1013 - Psychopathological assessment of the ultra-high risk state of psychosis: a five factor solution
European Psychiatry, 2012
ABSTRACT The ultra-high risk state of developing a psychosis is mainly characterized by attenuate... more ABSTRACT The ultra-high risk state of developing a psychosis is mainly characterized by attenuated or transient full-blown psychotic symptoms. It can be assessed with the structured interview for prodromal symptoms (SIPS), comprising four domains: positive, negative, disorganization and general symptoms. As the scores of the SOPS sub-domains are regularly used to perform domain-related analyses the stability of the suggested domain structure and item composition is of major interest.MethodSIPS (version 3.0) data from n = 243 participants of the European Prediction of Psychosis Study (EPOS) were used for the current analysis. Inclusion criteria comprised ultra-high risk criteria and the basic symptom criterion COGDIS. The EPOS investigators received extensive training by one of the scale's authors (Tandy J. Miller, PhD). Pairwise interrater concordance for SIPS was 77%, which was determined acceptable by the training team. A principal component analysis was performed (Eigenvalues > 1, varimax rotation).ResultsA five factor solution emerged. Factor 1 was primarily defined by a loss of intentionality, functioning and stress tolerance, factor 2 by anhedonia and affective blunting, factor 3 by cognitive and behavioural disorganization, factor 4 by delusions. Sleep disturbances and perceptual abnormalities/hallucinations have both been associated with dopaminergic disturbances, this may explain their common appearance on factor 5.DiscussionThe originally suggested structure of the SIPS proofed not to be stable and was replaced by a five-factor solution. Our results suggest considering a different item and factor structure in future SIPS based data analyses.
Poster #66 PERSISTENT POSITIVE SYMPTOMS IN PERSONS AT HIGH RISK OF PSYCHOSIS
Schizophrenia Research, 2012
Poster #79 THE MISMATCH NEGATIVITY IN DIFFERENT STAGES OF SCHIZOPHRENIA
Schizophrenia Research, 2012
Chances and risks of predicting psychosis
European Archives of Psychiatry and Clinical Neuroscience, 2012
Prevention is currently regarded a promising strategy for fighting the unfavorable consequences o... more Prevention is currently regarded a promising strategy for fighting the unfavorable consequences of psychosis. Yet, for the error probability inherent in any predictive approach, benefits and costs must be carefully weighed against each other. False attribution of risk may unnecessarily provoke stress and anxiety, and lead to unwarranted intervention exposure. However, clinical risk samples already exhibit psychopathological symptoms, cognitive and functional impairments, and help-seeking for mental problems. Thus, the risk of futile interventions is low as long as preventive measures also provide treatment for current complaints. Differentiation between still normal and clinically relevant mental states is another challenge as psychotic-like phenomena occur frequently in the general population, especially in younger adolescents. Reported prevalence rates vary with age, and if severe in terms of frequency and persistence, these phenomena considerably increase risk of psychosis in clinical as well as general population samples. Stigmatization is another concern, though insufficiently studied. Yet, at least more severe states of risk, which are accompanied by changes in thinking, feeling, and behavior, might lead to unfavorable, (self-) stigmatizing effects already by themselves, independent of any diagnostic "label," and to stress and confusion for the lack of understanding of what is going on. To further improve validity of risk criteria, advanced risk algorithms combining multi-step detection and risk stratification procedures should be developed. However, all prediction models possess a certain error probability. Thus, whether a risk model justifies preventive measures can only be decided by weighing the costs of unnecessary intervention and the benefits of avoiding a potentially devastating outcome.
Schizophrenia Research, 2012
Background: Ultra-high risk (UHR) criteria are defined by attenuated positive symptoms (APS) and/... more Background: Ultra-high risk (UHR) criteria are defined by attenuated positive symptoms (APS) and/or brief limited intermittent psychotic symptoms (BLIPS) and/or a combination of genetic risk factor and deterioration of functioning. They were originally developed for risk detection in cohorts of help-seeking individuals presenting themselves at specialized centers. Epidemiologically, these cohorts are risk enriched not only by the criteria but also by the (varying) filters established by the pathways to care. Thus, risk estimates observed in these cohorts cannot readily be generalized to broader defined mental health cohorts or even the general population. Furthermore, recent UHR studies indicated an unexpectedly large variance of short-term incidence of psychosis. Moreover, population based studies reported a considerable prevalence of psychotic symptoms in the general population, stimulating a debate about the UHR approach. On this background, introducing functional impairment as an obligate part of all UHR criteria has been considered. A higher specificity and implementation of a threshold of clinical importance have been discussed as most significant advantages. We used a sample of the naturalistic European Prediction of Psychosis Study (EPOS) to analyze the effects of introducing functional impairment as a general criterion on the detection of prodromal subjects. Methods: N=245 participants were included at six centers in four European countries, follow-up period was 18 months. Risk was defined by UHR criteria and/or the basic symptom criterion COGDIS. N=37 participants converted to psychosis; n=146 completed the whole follow-up period without conversion and were thus considered here. For the current analysis, we used the baseline scores of the Global Assessment of Functioning Scale,
Poster #66 A FIVE FACTOR SOLUTION OF THE SCALE OF PRODROMAL SYMPTOMS (SOPS)
Schizophrenia Research, 2012
Tiefe Hirnstimulation bei der Schizophrenie
Fortschritte der Neurologie · Psychiatrie, 2011
Deep brain stimulation (DBS) has successfully advanced our treatment options for putative therapy... more Deep brain stimulation (DBS) has successfully advanced our treatment options for putative therapy-resistant neuropsychiatric diseases. Building on this strong foundation, more and more mental disorders in the stadium of therapy-resistance are considered as possible indications for DBS. Especially, schizophrenia with its associated severe and difficult to treat symptoms is gaining attention. This attention demands critical questions regarding the assumed mechanisms of DBS and its possible influence on the supposed pathophysiology of schizophrenia. Here, we synoptically compare current approaches and theories of DBS and discuss the feasibility of DBS in schizophrenia as well as the transferability from other psychiatric disorders successfully treated with DBS. For this we consider recent advances in animal models of schizophrenic symptoms, results regarding the influence of DBS on dopaminergic transmission as well as data concerning neural oscillation and synchronisation. In conclusion, the use of DBS for some symptoms of schizophrenia seems to be a promising approach, but the lack of a comprehensive theory of the mechanisms of DBS as well as its impact on schizophrenia might hinder the use of DBS for schizophrenia at this point in time.
Insight in schizophrenia–course and predictors during the acute treatment phase of patients suffering from a schizophrenia spectrum disorder
European Psychiatry, 2012
To analyse insight of illness during the course of inpatient treatment, and to identify influenci... more To analyse insight of illness during the course of inpatient treatment, and to identify influencing factors and predictors of insight. Insight into illness was examined in 399 patients using the item G12 of the Positive and Negative Syndrome Scale ("lack of insight and judgement"). Ratings of the PANSS, HAMD, UKU, GAF, SOFAS, SWN-K and Kemp's compliance scale were performed and examined regarding their potential association with insight. The item G12 was kept as an ordinal variable to compare insight between subgroups of patients. Almost 70% of patients had deficits in their insight into illness at admission. A significant improvement of impairments of insight during the treatment (p<0.0001) was observed. At admission more severe positive and negative symptoms, worse functioning and worse adherence were significantly associated with poorer insight. Less depressive symptoms (p=0.0004), less suicidality (p=0.0218), suffering from multiple illness-episodes (p<0.0001) and worse adherence (p=0.0012) at admission were identified to be significant predictors of poor insight at discharge. The revealed predictors might function as treatment targets in order to improve insight and with it outcome of schizophrenia.
0127 LOCUS OF CONTROL IN PERSONS CLINICALLY AT RISK FOR PSYCHOSIS
Schizophrenia Research, 2006
0129 COPING STRATEGIES IN PERSONS CLINICALLY AT RISK FOR PSYCHOSIS
Schizophrenia Research, 2006
Acta Psychiatrica Scandinavica, 2008
Subjective quality of life (sQoL) and potentially contributing factors were investigated in indiv... more Subjective quality of life (sQoL) and potentially contributing factors were investigated in individuals putatively in an early (EIPS) or late initial prodromal state (LIPS) and healthy controls (HC). Participants comprised 58 EIPS individuals, 157 LIPS individuals and 87 HC individuals. sQoL was assessed together with locus of control (LoC), coping, demography and psychopathology. Putatively prodromal groups exhibited markedly lower sQoL than HC (all domains P < 0.00001). EIPS and LIPS individuals did not differ significantly. Depression was the most consistent explaining variable of sQoL in EIPS and LIPS individuals. In EIPS individuals, LoC emerged as an additional predictor. Individuals at risk for psychosis experienced a marked impairment of sQoL across all domains. This was evident even in the early state, showed no significant further deterioration during the late state and was predominantly explained by non-specific symptoms.
Poster #166 NEGATIVE SCHEMATIC BELIEFS ABOUT SELF AND OTHERS DIFFERENTIALLY PREDICT SUSPICIOUSNESS IN AT-RISK STATES
Schizophrenia Research, 2012
Schizophrenia Bulletin, 2011
sessions confirmed the application of CBT-specific skills in the CBT condition and the absence of... more sessions confirmed the application of CBT-specific skills in the CBT condition and the absence of those in CM. The overall quality rating of the CBT techniques applied in the CBT condition was good. When the final results of the trial are available, PREVENT will substantially expand the current limited evidence base for best clinical practice in people at-risk (prodromal) of first-episode psychosis.
Schizophrenia Research, 2000
In schizophrenia research, early detection in the initial prodrome before first psychotic episode... more In schizophrenia research, early detection in the initial prodrome before first psychotic episodes is a major topic. Therefore, the prognostic accuracy of initial prodromal symptoms was examined prospectively. The study sample was composed of patients referred to outpatient departments of German psychiatric university departments, because of diagnostic problems, between 1987 and 1991. They were examined with the Bonn Scale for the Assessment of Basic Symptoms and the Ninth Version of the Present State Examination to detect an incipient schizophrenic disorder. Of 385 patients showing no schizophrenia-characteristic symptoms, between 1995 and 1998, 110 with and 50 without initial prodromal symptoms were followed up and reexamined with the same instruments for a transition to schizophrenia. During a mean follow-up period of 9.6 years, 79 (49.4%) of the 160 patients had transited to schizophrenia. The absence of prodromal symptoms excluded a subsequent schizophrenia with a probability of 96% (sensitivity: 0.98; false-negative predictions: 1.3%), whereas their presence predicted schizophrenia with a probability of 70% (specificity: 0.59; false-positive predictions: 20%). Certain disturbances, such as thought interference, disturbances of receptive language, or visual distortions, predicted schizophrenia, even with a probability up to 91% (specificity: 0.85-0.91; false-positive predictions: 1.9%-7.5%). The Bonn Scale for the Assessment of Basic Symptoms operationalization of prodromal symptoms performed well in the early detection of schizophrenia. It therefore might be useful for the prediction of the disorder, especially if it is further refined to select those items with particularly high prognostic accuracy.
Das Diogenes-Syndrom
Fortschritte Der Neurologie Psychiatrie, 1985
... The Diogenes syndrome. Klosterkötter, J.;Peters, UH. Fortschritte der Neurologie, Psychiatrie... more ... The Diogenes syndrome. Klosterkötter, J.;Peters, UH. Fortschritte der Neurologie, Psychiatrie, Vol 53(11), Nov 1985, 427-434. doi: 10.1055/s-2007-1001988. Abstract. Discusses the Diogenessyndrome, reviewing the literature and presenting 2 case reports. ...
[Neuropsychological Functioning as a Predictor of Treatment Response to Psychoeducational, Cognitive Behavioral Therapy in People at Clinical High Risk of First Episode Psychosis]
Psychiatrische Praxis, 2015
Investigate whether treatment response in people at clinical high risk of psychosis (CHR) is pred... more Investigate whether treatment response in people at clinical high risk of psychosis (CHR) is predicted by their cognitive performance. 128 CHR outpatients were randomized into two treatment groups, one receiving integrated psychological intervention (IPI), including psychoeducation, the other receiving supportive counselling (SC) for 12 months. Multiple regression analysis was used to identify neurocognitive predictors of treatment response in a subgroup of n = 105, measured by symptomatic and functional improvement at 1-year follow-up. In the IPI, treatment response was associated with performance of executive control and processing speed (R² = 0.27, p = 0.002). In both treatment groups, performance of working memory/attention was a significant predictor (IPI: R² = 0.15, p = 0.039, SC: R² = 0.19, p = 0.012). Cognitive performance is associated with treatment response in CHR people. The enhancement of cognitive performance is a useful target of early intervention.
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Papers by Joachim Klosterkötter