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

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.

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

Psychological Medicine ◽

10.1017/s0033291718003859 ◽

2018 ◽

Vol 49 (4) ◽

pp. 529-534 ◽

Cited By ~ 16

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.

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

European Psychiatry ◽

10.1016/j.eurpsy.2016.11.010 ◽

2017 ◽

Vol 42 ◽

pp. 49-54 ◽

Cited By ~ 66

Author(s):

P. Fusar-Poli ◽

G. Rutigliano ◽

D. Stahl ◽

C. Davies ◽

A. De Micheli ◽

...

Keyword(s):

At Risk ◽

Mental Disorders ◽

Mental State ◽

Lower Risk ◽

Psychotic Disorders ◽

High Sensitivity ◽

Psychotic Symptoms ◽

Increased Risk ◽

At Risk Mental State

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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European status and perspectives on early detection and intervention in at-risk mental state and first episode psychosis: Viewpoint from the EPA section for prevention of mental disorders

European Psychiatry ◽

10.1016/j.eurpsy.2017.08.003 ◽

2017 ◽

Vol 46 ◽

pp. 48-50 ◽

Cited By ~ 7

Author(s):

N.P. Maric ◽

A. Raballo ◽

M. Rojnic Kuzman ◽

S. Andric Petrovic ◽

J. Klosterkötter ◽

...

Keyword(s):

At Risk ◽

Mental Disorders ◽

Early Detection ◽

Mental State ◽

First Episode Psychosis ◽

First Episode ◽

Episode Psychosis ◽

At Risk Mental State

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

European Psychiatry ◽

10.1016/j.eurpsy.2018.07.014 ◽

2018 ◽

Vol 54 ◽

pp. 98-99 ◽

Cited By ~ 1

Author(s):

Massimiliano Buoli ◽

Cecilia Maria Esposito ◽

Alice Caldiroli

Keyword(s):

At Risk ◽

Mental Disorders ◽

Mental State ◽

At Risk Mental State

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

10.21203/rs.3.rs-65345/v1 ◽

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.

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