scholarly journals The reality of at risk mental state services: a response to recent criticisms

2019 ◽  
pp. 1-7 ◽  
Author(s):  
Alison R. Yung ◽  
Stephen J. Wood ◽  
Ashok Malla ◽  
Barnaby Nelson ◽  
Patrick McGorry ◽  
...  
Keyword(s):  
At Risk ◽  
High Risk ◽  
Psychotic Disorder ◽  
Mental State ◽  
Help Seeking ◽  
Psychotic Symptoms ◽  
Ultra High Risk ◽  
Psychological Medicine ◽  
Poor Outcomes ◽  
At Risk Mental State

AbstractBackgroundIn the 1990s criteria were developed to detect individuals at high and imminent risk of developing a psychotic disorder. These are known as the at risk mental state, ultra high risk or clinical high risk criteria. Individuals meeting these criteria are symptomatic and help-seeking. Services for such individuals are now found worldwide. Recently Psychological Medicine published two articles that criticise these services and suggest that they should be dismantled or restructured. One paper also provides recommendations on how ARMS services should be operate.MethodsIn this paper we draw on the existing literature in the field and present the perspective of some ARMS clinicians and researchers.ResultsMany of the critics' arguments are refuted. Most of the recommendations included in the Moritz et al. paper are already occurring.ConclusionsARMS services provide management of current problems, treatment to reduce risk of onset of psychotic disorder and monitoring of mental state, including attenuated psychotic symptoms. These symptoms are associated with a range of poor outcomes. It is important to assess them and track their trajectory over time. A new approach to detection of ARMS individuals can be considered that harnesses broad youth mental health services, such as headspace in Australia, Jigsaw in Ireland and ACCESS Open Minds in Canada. Attention should also be paid to the physical health of ARMS individuals. Far from needing to be dismantled we feel that the ARMS approach has much to offer to improve the health of young people.

scholarly journals At-risk mental state for psychosis: identification and current treatment approaches

2016 ◽  
Vol 22 (3) ◽  
pp. 186-193 ◽  
Author(s):  
Andrew Thompson ◽  
Steven Marwaha ◽  
Matthew R. Broome
Keyword(s):  
Risk Factors ◽  
At Risk ◽  
High Risk ◽  
Psychotic Disorder ◽  
Mental State ◽  
Ethical Issues ◽  
Current Treatment ◽  
Ultra High Risk ◽  
Psychosis Prodrome ◽  
At Risk Mental State

SummaryThe concept of an ‘at-risk mental state’ for psychosis arose from previous work attempting to identify a putative psychosis prodrome. In this article we summarise the current criteria used to identify ‘at-risk’ individuals, such as the ultra-high-risk (UHR) criteria, and the further identification of important clinical risk factors or biomarkers to improve prediction of who might develop a psychotic disorder. We also discuss important ethical issues in classifying and treating at-risk individuals, current treatment trials in this area and what treatment current services can offer.

Transition to Psychosis: 6-Month follow-up of a Chinese High-Risk Group in Hong Kong

2006 ◽  
Vol 40 (5) ◽  
pp. 414-420 ◽  
Author(s):  
May M.L. Lam ◽  
Se-Fong Hung ◽  
Eric Y.H. Chen
Keyword(s):  
At Risk ◽  
High Risk ◽  
Mental State ◽  
Functional Decline ◽  
High Risk Group ◽  
Psychotic Symptoms ◽  
Syndrome Scale ◽  
History Of ◽  
At Risk Mental State

Objectives: The identification of individuals at high risk of becoming psychotic within the near future creates opportunities for early intervention before the onset of psychosis. This study sets out to identify a group of symptomatic young people in a Chinese population with the high likelihood of transition to psychosis within a follow-up period of 6 months, and to determine the rate of transition to psychosis in this group. Method: Symptomatic individuals with a family history of psychotic disorder, subthreshold psychotic symptoms or brief transient psychotic symptoms were identified using the operationalized criteria of an ‘At Risk Mental State’. The individuals were prospectively assessed monthly on a measure of psychopathology for 6 months. Results: Eighteen out of 62 individuals (29%) made the transition to frank psychosis within a 6 month follow-up period, with the majority occurring within 3 months. In addition, significant differences were found in the intake Positive and Negative Syndrome Scale, Comprehensive Assessment of ‘At Risk Mental State’ and Global Assessment of Functioning scores between the group that ultimately became psychotic and the group that did not. Conclusion: The period of the highest risk of transition to psychosis was within the 3 months after the study began. Thus, distressed youths in our outpatient clinic, who meet the high-risk criteria should be monitored most closely in the initial 3 months, particularly those individuals with high levels of psychopathology and functional decline.

scholarly journals ‘At risk mental state’ clinics for psychosis – an idea whose time has come – and gone!

2018 ◽  
Vol 49 (4) ◽  
pp. 529-534 ◽  
Author(s):  
Olesya Ajnakina ◽  
Anthony S. David ◽  
Robin M. Murray
Keyword(s):  
At Risk ◽  
Mental State ◽  
Help Seeking ◽  
First Episode ◽  
Public Health Approach ◽  
Medical Disorders ◽  
Increase Risk ◽  
Ultra High Risk ◽  
Artery Disease ◽  
At Risk Mental State

AbstractAt Risk Mental State (ARMS) clinics are specialised mental health services for young, help-seeking people, thought to be at ultra-high risk of developing psychosis. Their stated purpose is to reduce transitions from the ARMS state to clinical psychotic disorder. Reports of ARMS clinics provide ‘evidence-based recommendations’ or ‘guidance’ for the treatment of such individuals, and claim that such clinics prevent the development of psychosis. However, we note that in an area with a very well-developed ARMS clinic (South London), only a very small proportion (4%) of patients with first episode psychosis had previously been seen at this clinic with symptoms of the ARMS. We conclude that the task of reaching sufficient people to make a major contribution to the prevention of psychosis is beyond the power of ARMS clinics. Following the preventative approaches used for many medical disorders (e.g. lung cancer, coronary artery disease), we consider that a more effective way of preventing psychosis will be to adopt a public health approach; this should attempt to decrease exposure to environmental factors such as cannabis use which are known to increase risk of the disorder.

Clinical and Functional Outcomes of At-Risk Mental State Among Non-Help Seeking Adolescents

2020 ◽  
Author(s):  
Patrik Švancer ◽  
Aneta Dorazilová ◽  
Veronika Voráčková ◽  
Pavel Knytl ◽  
Pavel Mohr ◽  
...  
Keyword(s):  
At Risk ◽  
Cognitive Performance ◽  
Mental State ◽  
Verbal Memory ◽  
Visual Memory ◽  
Help Seeking ◽  
Mental States ◽  
Psychotic Symptoms ◽  
Negatively Associated ◽  
At Risk Mental State

Abstract Background: At-risk mental state (ARMS) individuals are at high risk to develop psychosis. In addition to attenuated symptoms, ARMS is associated with cognitive and functional impairment. The findings are mostly based on research in help-seeking at-risk population. Our study aim was to explore prevalence rates of ARMS, comorbidities, functioning, and cognitive performance among non-help seeking adolescents. Patients and methods: Study subjects were randomly selected high school adolescents. At-risk mental state was assessed with Comprehensive Assessment of At Risk Mental States interview (CAARMS). Kiddie-Schedule for Affective Disorders and Schizophrenia examined comorbidities. Social functioning and quality of life were measured with Social and Occupational Functioning Assessment Scale (SOFAS) and KIDSCREEN 52. Cognitive performance in the domains of visual memory, verbal memory, working memory, and processing speed was assessed with a battery of cognitive tests Results: The total of 82 adolescents was enrolled, 21 of them met the ARMS criteria. No case of threshold psychotic disorder was detected in the study sample. Subthreshold mental disorders were more frequent in the ARMS+ group than in the ARMS- group (OR= 3.05; 95%CI 1.07, 8.67; p=0.03). Lower SOFAS scores were observed in the ARMS+ group compared to the ARMS- group (t= -3.888; p<.001; Cohen’s d = 0.99). In the total sample, CAARMS symptoms intensity was negatively associated with the SOFAS score (β = -.51; R2 = 0.26; p<.001). No significant differences in the KIDSCREEN-52 scores or cognitive functioning were found between the groups. Conclusion: Our findings suggest that non-help seeking adolescents with at-risk mental state have worse level of functioning compared to controls and higher rates of non-psychotic psychiatric comorbidities. Reduction in functioning is negatively associated with the severity of their subsyndromal psychotic symptoms.

scholarly journals Negative psychotic symptoms and impaired role functioning predict transition outcomes in the at-risk mental state: a latent class cluster analysis study

2013 ◽  
Vol 43 (11) ◽  
pp. 2311-2325 ◽  
Author(s):  
L. R. Valmaggia ◽  
D. Stahl ◽  
A. R. Yung ◽  
B. Nelson ◽  
P. Fusar-Poli ◽  
...  
Keyword(s):  
At Risk ◽  
Cluster Analysis ◽  
Mental State ◽  
Latent Class ◽  
Mental States ◽  
Psychotic Symptoms ◽  
Role Functioning ◽  
Latent Class Cluster Analysis ◽  
At Risk Mental State

BackgroundMany research groups have attempted to predict which individuals with an at-risk mental state (ARMS) for psychosis will later develop a psychotic disorder. However, it is difficult to predict the course and outcome based on individual symptoms scores.MethodData from 318 ARMS individuals from two specialized services for ARMS subjects were analysed using latent class cluster analysis (LCCA). The score on the Comprehensive Assessment of At-Risk Mental States (CAARMS) was used to explore the number, size and symptom profiles of latent classes.ResultsLCCA produced four high-risk classes, censored after 2 years of follow-up: class 1 (mild) had the lowest transition risk (4.9%). Subjects in this group had the lowest scores on all the CAARMS items, they were younger, more likely to be students and had the highest Global Assessment of Functioning (GAF) score. Subjects in class 2 (moderate) had a transition risk of 10.9%, scored moderately on all CAARMS items and were more likely to be in employment. Those in class 3 (moderate–severe) had a transition risk of 11.4% and scored moderately severe on the CAARMS. Subjects in class 4 (severe) had the highest transition risk (41.2%), they scored highest on the CAARMS, had the lowest GAF score and were more likely to be unemployed. Overall, class 4 was best distinguished from the other classes on the alogia, avolition/apathy, anhedonia, social isolation and impaired role functioning.ConclusionsThe different classes of symptoms were associated with significant differences in the risk of transition at 2 years of follow-up. Symptomatic clustering predicts prognosis better than individual symptoms.

scholarly journals Identifying patients at risk of psychosis: a qualitative study of GP views in South West England

2020 ◽  
pp. bjgp20X713969
Author(s):  
Daniela Strelchuk ◽  
Nicola Wiles ◽  
Catherine Derrick ◽  
Stanley Zammit ◽  
Katrina Turner
Keyword(s):  
Primary Care ◽  
At Risk ◽  
Patient Group ◽  
Continuity Of Care ◽  
Mental State ◽  
Psychotic Symptoms ◽  
Structured Interviews ◽  
South West ◽  
South West England ◽  
At Risk Mental State

BackgroundEarly intervention in people with an at-risk mental state for psychosis can decrease the rates of transition to psychosis. GPs play a key role in the identification of this patient group but very few studies have explored GPs’ awareness of patients who are at risk of psychosis.AimTo explore GPs’ views and experiences of identifying patients with an at-risk mental state for psychosis, and the barriers and facilitators to identification.Design and settingIn-depth semi-structured interviews were held with GPs working in South West England primary care. The interviews were conducted between March and July 2019.MethodA topic guide was used to ensure consistency across interviews. This guide was revised to incorporate a definition of the at-risk mental state for psychosis, as after conducting a few interviews it became clear that some GPs were not familiar with this construct. Interviews were audiorecorded and analysed thematically.ResultsA total of 20 GPs were interviewed. Some GPs were not familiar with the concept of being at risk of developing psychosis, and perceived that they may not have the right skills to identify this patient group. Other barriers related to patients not presenting or disclosing psychotic symptoms, and limitations imposed by scarce resources on the structure and provision of NHS services, such as lack of continuity of care and high thresholds for accessing specialised services.ConclusionIdentifying people at risk of psychosis in primary care is difficult. Provision of GP training, development of policies that support continuity of care, and improved access to specialised services could help improve the identification of this patient group.

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

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

The Relationship Between Negative Symptoms and Cognitive Functioning in Patients with an at Risk Mental State for Psychosis

2017 ◽  
Vol 41 (S1) ◽  
pp. S270-S271
Author(s):  
L. Leanza ◽  
L. Egloff ◽  
E. Studerus ◽  
C. Andreou ◽  
U. Heitz ◽  
...  
Keyword(s):  
At Risk ◽  
Cognitive Functioning ◽  
Mental State ◽  
Verbal Fluency ◽  
Negative Symptoms ◽  
Psychotic Symptoms ◽  
First Episode ◽  
Clinical Impression ◽  
The Relationship ◽  
At Risk Mental State

IntroductionNegative symptoms and cognitive impairments are both present in patients with an at risk mental state (ARMS) for psychosis and negatively affect functioning and outcome. According to previous studies in patients with first-episode psychosis, negative symptoms are negatively associated with cognitive functioning while positive symptoms do not seem to be associated. Yet, little is known about the specific relationship of negative symptoms and cognitive functioning in ARMS patients.ObjectiveTo evaluate, the relationship between negative symptoms and cognitive functioning in ARMS patients.MethodsData of 154 ARMS patients were collected within the prospective Basel early detection of psychosis (FePsy) study. Negative symptoms were assessed with the SANS, positive psychotic symptoms with the BPRS, cognitive functioning with an extensive neuropsychological test battery. Multiple regressions were applied and results were controlled for age and gender.ResultsRegression analyses showed a significant, negative association between negative but not positive psychotic symptoms and cognitive functioning, showing the strongest association with verbal fluency (see Fig. 1). However, results mainly did not withstand correction for multiple testing.ConclusionsThe association found between verbal fluency and negative symptoms may be indicative of an overlap between those constructs. Finally, verbal fluency might have a strong influence on the clinical impression of negative symptoms, especially on alogia.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Sign in / Sign up

Export Citation Format

Share Document