Identification of young people at risk of psychosis

Operational criteria for detecting prodromal, or at-risk, mental states have been developed largely on the basis of individuals seeking help for attenuated or brief, self-limiting symptoms that do not meet threshold criteria for psychotic disorder. These individuals present largely to primary care and other non-specialist mental health settings. Follow-up studies have confirmed that 15–40% will make the transition to full psychosis within 12 months. Cognitive therapy alone or in combination with low-dose atypical antipsychotics has been shown to be efficacious in reducing or delaying the transition to psychosis, as well as in ameliorating the severity of non-psychotic symptoms and distress. Antipsychotic medication alone has not shown significant efficacy, but results are suggestive of some advantage from drug treatment. Further work is needed to clarify the relative merits of these interventions.

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

Psychological Medicine ◽

10.1017/s0033291713000251 ◽

2013 ◽

Vol 43 (11) ◽

pp. 2311-2325 ◽

Cited By ~ 71

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.

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Increased serum interleukin-6 levels in early stages of psychosis: Associations with at-risk mental states and the severity of psychotic symptoms

Psychoneuroendocrinology ◽

10.1016/j.psyneuen.2013.12.005 ◽

2014 ◽

Vol 41 ◽

pp. 23-32 ◽

Cited By ~ 95

Author(s):

Alexander Stojanovic ◽

Lourdes Martorell ◽

Itziar Montalvo ◽

Laura Ortega ◽

Rosa Monseny ◽

...

Keyword(s):

At Risk ◽

Interleukin 6 ◽

Mental States ◽

Psychotic Symptoms ◽

Early Stages ◽

At Risk Mental States

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Clinical features of adolescents diagnosed with eating disorders and at risk for psychosis

European Psychiatry ◽

10.1192/j.eurpsy.2020.80 ◽

2020 ◽

Vol 63 (1) ◽

Author(s):

Martina Maria Mensi ◽

Chiara Rogantini ◽

Renata Nacinovich ◽

Anna Riva ◽

Livio Provenzi ◽

...

Keyword(s):

At Risk ◽

Eating Disorders ◽

Social Functioning ◽

Psychological Symptoms ◽

Mental States ◽

Self Report ◽

Psychotic Symptoms ◽

Psychological Features ◽

At Risk Mental States

Abstract Background. The presence of subthreshold psychotic symptoms in adolescents with eating disorders is poorly described. This study provides a detailed characterization of adolescents affected by eating disorders in the absence or presence of subthreshold psychotic symptoms, taking into account a wide set of sociodemographic, psychological, and clinical variables. Methods. Ninety-four adolescents diagnosed with eating disorders were interviewed, focusing on clinical anamnesis and sociodemographic data collection. The Comprehensive Assessment of At-Risk Mental States (CAARMS) was used to assess the presence (HR+) or absence (HR−) of subthreshold psychosis. The clinicians completed a questionnaire on eating disorders severity, whereas patients provided self-report measures of global social functioning and psychological symptoms associated with eating disorders. Results. Attenuated psychotic symptoms were highly frequent (84% of subjects). HR+ patients experienced more frequently purging behaviors and dysmorphophobia and received a greater amount of antipsychotic drugs. Compared to HR− counterparts, HR+ patients reported higher eating disorders severity and psychological symptoms (i.e., ineffectiveness, interpersonal and affective problems) associated with eating disorders. Finally, a significant correlation between global social functioning and eating disorders severity emerged only for HR− subjects. Conclusions. These descriptive data are warranted to identify a potential psychotic core in eating disorders, mainly concerning body image and weight as well as specific psychological features. The availability of reliable and valid markers of risk can further increase our capacity to detect the early emergence of psychosis in adolescents with eating disorders, whose outcome might be worsened by the presence of psychotic symptoms.

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Cognitive behavioural therapy for worry in young individuals with at-risk mental states: a preliminary investigation

The Cognitive Behaviour Therapist ◽

10.1017/s1754470x19000229 ◽

2019 ◽

Vol 12 ◽

Author(s):

Andrea Pozza ◽

Sandro Domenichetti ◽

Davide Dèttore

Keyword(s):

Mental Health ◽

At Risk ◽

Psychiatric Care ◽

Mental States ◽

Behavioural Therapy ◽

Post Treatment ◽

Future Research ◽

Cognitive Behavioural ◽

At Risk Mental States

Abstract Cognitive behavioural therapy (CBT) is a first-line strategy in reducing or delaying risk of transition to psychosis among young individuals with at-risk mental states (ARMS). However, there is little knowledge about its effects on other outcomes associated with ARMS. No study on CBT for ARMS has assessed worry, an important process associated with this condition. The present study investigated changes in worry at immediate post-treatment and 14-month follow-up after CBT for young individuals with ARMS seeking psychiatric care in mental health services. Thirty-seven young individuals (mean age = 26 years, SD = 6.07; 22.20% female) seeking psychiatric care in mental health services and classified as reporting ARMS through the Comprehensive Assessment of At-Risk Mental States were included. The Positive And Negative Syndrome Scales (PANSS) and Penn State Worry Questionnaire (PSWQ) were administered at baseline, post-treatment, and follow-up. CBT consisted of 30 weekly individual 1-hour sessions based on a validated CBT for ARMS manual enriched with components targeting worry [psychoeducation, problem-solving, (meta)cognitive restructuring, behavioural experiments]. Seven participants (18.91%) at follow-up had cumulatively made transition to psychosis. Repeated measures ANOVA with post-hoc pairwise comparisons showed significant changes in PSWQ scores from baseline to post-treatment and from baseline to follow-up; PSWQ scores remained stable from post-treatment to follow-up. This is the first study investigating changes in worry after CBT for ARMS, which appears to be a promising strategy also for this outcome. Future research with a larger sample size and control group may determine whether changes in worry are also associated with reduced transition risk. Key learning aims (1) To understand CBT evidence and procedures for young individuals with ARMS. (2) To reflect on the current limitations in the literature on CBT for ARMS. (3) To understand the importance and clinical implications of assessing worry in ARMS. (4) To focus on changes in worry as an outcome after CBT for ARMS. (5) To reflect on future research directions on the role of worry in CBT for ARMS.

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