Commentary on “Long-term validity of the At Risk Mental State (ARMS) for predicting psychotic and non-psychotic mental disorders”

AbstractBackgroundThe long-term clinical validity of the At Risk Mental State (ARMS) for the prediction of non-psychotic mental disorders is unknown.MethodsClinical register-based cohort study including all non-psychotic individuals assessed by the Outreach And Support in South London (OASIS) service (2002–2015). The primary outcome was risk of developing any mental disorder (psychotic or non-psychotic). Analyses included Cox proportional hazard models, Kaplan–Meier survival/failure function and C statistics.ResultsA total of 710 subjects were included. A total of 411 subjects were at risk (ARMS+) and 299 not at risk (ARMS−). Relative to ARMS−, the ARMS+ was associated with an increased risk (HR = 4.825) of developing psychotic disorders, and a reduced risk (HR = 0.545) of developing non-psychotic disorders (mainly personality disorders). At 6-year, the ARMS designation retained high sensitivity (0.873) but only modest specificity (0.456) for the prediction of psychosis onset (AUC 0.68). The brief and limited intermittent psychotic symptoms (BLIPS) subgroup had a higher risk of developing psychosis, and a lower risk of developing non-psychotic disorders as compared to the attenuated psychotic symptoms (APS) subgroup (P < 0.001).ConclusionsIn the long-term, the ARMS specifically predicts the onset of psychotic disorders, with modest accuracy, but not of non-psychotic disorders. Individuals meeting BLIPS criteria have distinct clinical outcomes.Significant outcomesIn the long-term, the ARMS designation is still significantly associated with an increased risk of developing psychotic disorders but its prognostic accuracy is only modest. There is no evidence that the ARMS is associated with an increased risk of developing non-psychotic mental disorders. The BLIPS subgroup at lower risk of developing non-psychotic disorders compared to the APS subgroup.LimitationsWhile incident diagnoses employed in this study are high in ecological validity they have not been subjected to formal validation with research-based criteria.

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Mental disorders diagnosed in childhood and at-risk mental state in a help-seeking population

Early Intervention in Psychiatry ◽

10.1111/j.1751-7893.2012.00376.x ◽

2012 ◽

Vol 7 (2) ◽

pp. 187-192

Author(s):

Anna Comparelli ◽

Daniela Pucci ◽

Valeria Savoja ◽

Giorgio D. Kotzalidis ◽

Ilaria Falcone ◽

...

Keyword(s):

At Risk ◽

Mental Disorders ◽

Mental State ◽

Help Seeking ◽

At Risk Mental State

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Effects of the Health-Awareness-Strengthening Lifestyle Program in a Randomized Trial of Young Adults with an At-Risk Mental State

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18041959 ◽

2021 ◽

Vol 18 (4) ◽

pp. 1959

Author(s):

Ching-Lun Tsai ◽

Ya-Wen Lin ◽

Hsing-Chi Hsu ◽

Mei-Ling Lou ◽

Hsien-Yuan Lane ◽

...

Keyword(s):

At Risk ◽

Health Promotion ◽

Young Adults ◽

Mental State ◽

Control Group ◽

Health Awareness ◽

Post Test ◽

Experimental Group ◽

At Risk Mental State

Background: Increasing health awareness in health promotion is considered as one of the less stigmatized interventions for improving help-seeking behaviors and total well-being. This study aimed to explore the short-term and long-term effectiveness of the health-awareness-strengthening lifestyle (HASL) program on Taiwanese young adults with at-risk mental state. Methods: A pre- and post-test randomized trial was conducted on 92 young adults with at-risk mental state. The HASL program was provided to the experimental group as intervention, and it was only provided to the control group passively by request after the post-test for ethical reasons. The program was conducted once every six weeks, 60–90 min per session, for a total of three times. Mental health risk, anxiety level, health promotion lifestyles, quality of life, physiological index, and physical exercises were assessed one week before and after the program for both groups and followed up to 6 and 12 months for experimental group only. Results: Compared to the control group, those in the experimental group showed significant improvements regarding anxiety level, health promotion lifestyles, and quality of life one week after participating in the program. Furthermore, the experimental group also showed an additional long-term positive effect on mental risk, physical exercises, and physical health after the follow-ups. Conclusions: The outcomes highlighted the interventions of the HASL program leading to more positive health effects on young adults with at-risk mental state. The implementation of similar clinical service is recommended for young adults with at-risk mental state.

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Long-term rates of remission and late psychotic transition of individuals at risk for psychosis

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.2105 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S186-S186 ◽

Cited By ~ 2

Author(s):

K. Beck ◽

C. Andreou ◽

E. Studerus ◽

L. Egloff ◽

U. Heitz ◽

...

Keyword(s):

At Risk ◽

Mental State ◽

Research Field ◽

Initial Assessment ◽

Psychotic Symptoms ◽

Term Outcome ◽

Long Term Outcome ◽

At Risk Mental State

IntroductionIn the growing research field of early psychosis detection in patients with an at risk mental state (ARMS), most studies focus on the transition to frank psychosis. However, the majority of ARMS patients do not go on to develop frank psychosis and reported transition rates are declining. Little is known about the long-term outcome of these non-transitioned patients (ARMS-NT).ObjectivesTo investigate in preliminary analyses the long-term outcome of ARMS-NT patients with respect to persistence of ARMS signs and symptoms and the rates of late psychotic transition.MethodsThe ongoing study “FePsy-BHS-NT” follows up ARMS-NT without transition during at least the first two years for up to 15 years after their initial assessment. ARMS status is ascertained with the Basel Screening Instrument for Psychosis (BSIP). ARMS remission is defined as the absence of attenuated psychotic symptoms or brief limited intermittent psychotic symptoms for at least 12 consecutive months.ResultsIn this preliminary sample of 51 ARMS-NT, the majority of patients (70.6%) have remitted from their at risk mental state, 13.7% remain at risk and 15.7% have made a late psychotic transition during the course of long-term follow up (median = 5.75, range 4–11 years after initial assessment).ConclusionsThe considerable rates of ARMS persistence and late psychotic transition indicate that longer follow-up durations than commonly recommended should be contemplated in ARMS patients. Potential predictors of favorable long-term clinical outcome, as well as psychosocial, neurocognitive and other outcomes of ARMS-NT patients will be further evaluated in the present study.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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CBT in the prevention of psychosis and other severe mental disorders in patients with an at risk mental state: A review and proposed next steps

Schizophrenia Research ◽

10.1016/j.schres.2017.08.018 ◽

2019 ◽

Vol 203 ◽

pp. 88-93 ◽

Cited By ~ 9

Author(s):

Mark van der Gaag ◽

David van den Berg ◽

Helga Ising

Keyword(s):

At Risk ◽

Mental Disorders ◽

Mental State ◽

Severe Mental Disorders ◽

At Risk Mental State

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Treating Prodromal Psychosis in Slovenia

European Psychiatry ◽

10.1016/s0924-9338(09)71342-2 ◽

2009 ◽

Vol 24 (S1) ◽

pp. 1-1

Author(s):

M. Blinc ◽

B. Novak ◽

B. Avgustin ◽

M. Agius

Keyword(s):

At Risk ◽

Group Psychotherapy ◽

Clinical Evaluation ◽

Mental State ◽

Low Doses ◽

Psychotic Illness ◽

Readmission Rates ◽

Prodromal Phase ◽

At Risk Mental State

This presentation describes an ongoing program in Ljubljana.The program originated with one psychiatrist [MB] who began to offer treatment with antipsychotics- typicals with the earliest patients, and later atypicals, in particular olanzapine, in very low doses [e.g.2.5 mg olanzapine], often combined with group psychotherapy, in patients considered to be at the initial [prodromal or ‘at risk mental state’] phase of developing a psychotic illness. Often, where indicated, antidepressants and occasionally anxiolytics were also added to the treatment. Thus this program differed substantially from other well known studies of treatment in the prodrome [e.g. Melbourne and Yale], and developed independently of them.It has been shown by repeated clinical evaluation of the patients that these patients were indeed originally in the prodromal phase of psychotic illness.Many patients have now been followed over several years as they developed into full first episodes of psychosis and for some years later.The presentation will describe the process of how the patients were treated, and how their illness developed.The presentation will describe results, of a study comparing outcomes of treatment in the prodrome by this method, with treatment of patients who presented with psychotic illness in the usual way, with long DUP. This shows long term advantages in terms of severity of symptoms, reduced relapse and readmission rates, better employment results, and improved relationships among the patients treated in the prodrome.

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