Child and Adolescent Mental Health Research Chair

Dr. Jean Addington, the inaugural Alberta Centennial Mental Health Research Chair, is one of the leading researchers in the area of early detection and prevention of psychosis, via early intervention in the prodromal phase of the illness. Schizophrenia often strikes young people in their early 20s, but there is reason to believe that individuals with pre-psychotic symptoms can be identified, at a point when early education, psychosocial intervention, or medication could either prevent or delay the onset of a more serious psychotic illness.

It is believed that this disability develops in the years preceding the onset of psychotic symptoms, the prodromal period, in which social withdrawal and the evolution of negative symptoms form the foundation on which psychotic symptoms develop. Working with adolescents as young as 13 years old, Dr. Addington seeks to determine whether symptoms can be predicted and treated prior to a full blown psychotic episode. The goal of Dr. Addington's research is to minimize the impact of the disease early on, thus moving psychotic illness from the category of severe and persistent mental illness into the same realm as disorders such as anxiety, depression, or chronic medical conditions such as diabetes. She argues that, "if you encourage people to get help before they become psychotic, hopefully the symptoms can be controlled before they become severe and more disrupting and disabling."

The Chairs Program aims to address two major, related goals: increasing Alberta's excellence and output of mental health research findings, and the translation of these findings into practice improvements. Dr. Addington's research suggests that, if the long-term disability so often associated with schizophrenia is to be addressed, it is likely going to require the development of approaches to identifying and treating individuals during this critical very early phase of the illness, childhood and adolescence. Moreover, this research can serve to inform mental health policy about the delivery of preventative approaches to mental illness, potentially reducing personal, social, and healthcare costs. Through knowledge gained regarding prodromal symptoms in psychosis and associated practice improvements, Dr. Addington's research will help fulfill the Program goals by promoting evidence-driven changes in mental health practice.

Read more about Dr. Addington's work at her University of Calgary website here.

Research Summaries

Dr. Addington has numerous publications related to her research. Here are a few abstracts from some of her more recent publications.

Auther, A. M., Cadenhead, K. S., Carrión, R. E., Addington, J., Bearden, C. E., Cannon, T. D., McGlashan, T. H., Perkins, D. O., Seidman, L., Tsuang, M., Walker, E. F., Woods, S. W., Cornblatt, B. A. (2015). Alcohol confounds relationship between cannabis misuse and psychosis conversion in a high-risk sample. Acta Psychiatrica Scandinavica, 132(1), 60–68.
Background: Cannabis use has been examined as a predictor of psychosis in clinical high-risk samples, but little is known about the impact of other substances on this relationship.
Methods: Substance use was assessed in a large sample of clinical high-risk participants (N = 370, mean age = 18.3) enrolled in the multisite North American Prodrome Longitudinal Study Phase 1 project. Three hundred and forty-one participants with cannabis use data were divided into groups: No Use (n = 211); Cannabis Use without impairment (n = 63); Cannabis Abuse/Dependence (n = 67). Participants (n = 283) were followed for over 2 years to determine psychosis conversion.
Results: Alcohol (45.3%) and cannabis (38.1%) were the most common substances. Cannabis use groups did not differ on baseline attenuated positive symptoms. Seventy-nine of 283 participants with cannabis and follow-up data converted to psychosis. Survival analysis revealed significant differences between conversion rates in the Cannabis Abuse/Dependence group compared with the No Use (p = 0.031) and Cannabis Use without impairment group (p = 0.027). Cannabis Abuse/Dependence also significantly predicted psychosis in a regression analysis, but adjusting for alcohol use weakened this relationship.
Conclusion: The cannabis misuse and psychosis association was confounded by alcohol use. Non-impairing cannabis use was not related to psychosis. Results highlight the need to control for other substance use, so as to not overstate the cannabis/psychosis connection.

McAusland, L., Buchy, L., Cadenhead, K. S., Cannon, T. D., Cornblatt, B. A., Heinssen, R., McGlashan, T. H., Perkins, D. O., Seidman, L. J., Tsuang, M. T., Walker, E. F., Woods, S. W., Bearden, C. E., Mathalon, D. H., Addington, J. (2015). Anxiety in youth at clinical high risk for psychosis. Early Intervention in Psychiatry.
Background: High rates of anxiety have been observed in youth at clinical high risk of developing psychosis. In clinical high risk, anxiety often co-occurs with depression, and there is inconsistent evidence on anxiety in relation to transition to psychosis. The aim of this study was to examine: (i) the prevalence of anxiety disorders in individuals at clinical high risk; (ii) clinical differences between those with and without anxiety; and (iii) the association of baseline anxiety with later transition to psychosis.
Methods: The sample consisted of 765 clinical high risk individuals and 280 healthy controls. Clinical high risk status was determined with the Structured Interview of Prodromal Syndromes, mood and anxiety diagnoses with the Structured Clinical Interview for DSM-IV Disorders, and severity of anxiety with the Social Interaction Anxiety Scale and Self-Rating Anxiety Scale.
Results: In the clinical high risk sample, 51% met criteria for an anxiety disorder. Clinical high risk participants had significantly more anxiety diagnoses and severity than healthy controls. Anxiety was correlated to attenuated psychotic and negative symptoms in clinical high risk and those with an anxiety disorder demonstrated more suspiciousness. Clinical high risk participants with obsessive-compulsive disorder (OCD) exhibited more severe symptomatology than those without OCD. An initial presentation of anxiety did not differ between those who did or did not transition to psychosis.
Conclusion: In this large sample of individuals at clinical high risk, anxiety is common and associated with more severe attenuated psychotic symptoms. Treatment not only to prevent or delay transition to psychosis but also to address presenting concerns, such as anxiety, is warranted.

Addington, J. (2011). Clinical presentation of and social risk factors in young people at clinical high risk for psychosis. Biological Psychiatry, 69, 106s.
Background: NAPLS 2 is a multi-site study investigating predictors and mechanisms of conversion to psychosis.
Methods: The midpoint sample consists of 275 prospectively identified clinical high risk (CHR) participants who meet Structured Interview for Prodromal Syndromes criteria and 155 controls. The sample was assessed on a range of clinical measures and social risk factors for psychosis.
Results: More than 40% of CHR individuals have a comorbid diagnosis in particular mood, anxiety and substance use. The CHR group rate significantly higher on anxiety and depression than controls (p<0.0001) and have an increased use of tobacco and marijuana (p<0.0001). Furthermore, the CHR group reported higher rates of childhood trauma including bullying, emotional neglect, and psychological, physical and sexual abuse compared to the control group (p<0.0001). The CHR group perceived that they were discriminated against significantly more often than controls did (p<0.01 to p<0.0001). The CHR group rated significantly higher on ratings of self schemas. The groups did not differ in early childhood head injury or the use of cannabis before age 15.
Conclusions: As has been previously demonstrated, there is no doubt that these young people, in addition to being at risk of developing psychosis have evidence of other clinical problems. Furthermore, there are higher rates in the CHR group of childhood social adversity that is considered to create risk for psychosis. Finally, there is support for the link between childhood social adversity and the self-schemas that may play a role in the development of psychotic symptoms.

Cadenhead, K., Addington, J., Cannon, T., Cornlatt, B., McGlashan, T., Perkins, D., et al., (2011). Greater prepulse inhibition prior to the onset of psychosis. Findings from the North American Prodrome Longitudinal Study, Biological Psychiatry, 69, 13.
Background: The use of biomarkers in the study of the prodromal period of psychosis provides a means of not only identifying individuals at greatest risk for psychosis but also understanding neurodevelopmental abnormalities early in the course of illness. Prepulse inhibition (PPI) is an important translational paradigm that is deficient in schizophrenia, heritable and reduced after developmental manipulations in animal models.
Methods: PPI was assessed in 103 at risk (AR) and 75 healthy comparison (HC) subjects from the North American Prodrome Longitudinal Study (NAPLS) consortium at baseline assessment.
Results: There was a significant group effect (F[1,173]=8.21, p<0.005) with the AR subjects demonstrating greater PPI than the HC group. There were no significant effects of gender, site or age on PPI and these results were independent of startle reactivity that was also larger (F[1,181]=6.00, p<0.05) in AR subjects.
Conclusions: This finding of greater PPI in AR subjects from the NAPLS sample, along with separate findings from a San Diego sample that demonstrate greater PPI in a small group of AR subjects who later convert to psychosis, suggests that PPI may reveal compensatory changes prior to disease onset. Further investigation of this novel finding with longitudinal assessment will be essential as we gain new insights into the early course of psychosis.

Stowkowy, J., & Addington, J. (2011). Maladaptive schemas in young people at clinical high risk for psychosis. Schizophrenia Bulletin, 37, (S1), 282-283.
Background: In depression research it is accepted that adverse early socialexperiences can lead to enduring cognitive vulnerabilities that are characterized by negative schemas or beliefs about the self, others and the world. In schizophrenia research there are studies suggesting a role for social risk factors (eg child abuse, early social adversity, urban upbringing, social isolation, immigrant status) in the development of schizophrenia. One proposal by Selten (2005) is that social defeat may be the mechanism that links these ‘‘adversities’’ and is a contributing factor to psychosis. At the same time the development of cognitive models suggesting that people’s beliefs and appraisal processes are very important in the onset and persistence of psychosis. The aim of this study was to examine if maladaptive schema and self beliefs are a link between social defeat and the onset of psychosis, ie that young people at clinical high risk (CHR) of developing a psychotic illness, who were characterized by a sense of social defeat would also have developed maladaptive self beliefs and self schema that increased their risk of developing psychosis.
Methods: In a sample of 38 CHR individuals (28 males, 10 females, mean age 19.7 years) who met criteria for prodromal risk syndrome based on the Structured Interview for Prodromal Syndromes, we examined attenuated positive symptoms (SOPS), social defeat and cognitive schemas (Brief Schema Scales, Attitude Scale, Schema Questionnaire).
Results: Relative to published norms the sample demonstrated high levels of social defeat and feelings of both internal and external entrapment, endorsed negative evaluations of the self and others and demonstrated maladaptive schemas (eg emotional deprivation, shame, failure, mistrust). All negative evaluations and maladaptive schemas were significantly associated with a greater sense of social defeat and entrapment (r ranged from .47 to .82, P < .01 for all correlations) and with high levels of attenuated positive symptoms (r ranged from .41 to .47, P < .01 for all correlations).
Conclusion: In conclusion, those at clinical high risk of psychosis who have developed maladaptive self- beliefs and self-schema have higher levels of attenuated positive symptoms. This could offer some support for the notion that maladaptive self beliefs may play a role in the onset of psychosis and have implications for prevention because these maladaptive schemas are malleable factors for which we have effective psychological interventions.  

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