Predicting the transition to psychosis Flashcards
(40 cards)
What was Maudsley’s view on preventing psychosis (1909)?
“early treatment… will prevent the necessity… of placing some patients in a lunatic asylum”
What did the ‘ABC’ first episode study of Häfner and Nowotny (1995) show?
Prodromal symptoms: which precede the onset of first episode psychosis
- term adopted in retrospective view: not clinically suitable as way of altering and intervening on the longitudinal development of the illness
What is the problem of retrospective research on the first onset of psychosis?
No way to change the course of psychosis
What is the goal of prospective intervention on the transition to psychosis?
Being able to identify individuals who will later develop psychosis within samples at clinical high risk
-> intervening prospectively
What characterises the major advancement in knowledge on prodromal psychosis over the past 20 years (Fusar-Poli et al., 2013)?
Exponential growing interest in research in clinical literature
- indexing our ability to prospectively identify individuals at clinical high risk of develop psychosis
What are the conflicting findings within the exponential and growing research on the prospective intervention on psychosis development?
Confusion regarding the different psychometric tools currently available to prospectively identify individuals at high risk of developing psychosis
What is the use of CAARMS?
Check for different inclusion criteria for individuals at high risk state for psychosis
What are the three inclusion criteria to qualify for an ‘at risk mental state’ in CAARMS (Fusar-Poli et al., 2013)?
- Attenuated Psychosis Syndrome
- Brief Limited Intermittent Psychotic Symptoms
- Genetic Risk and Deterioration Syndrome
What characterises the ‘Attenuated Psychosis Syndrome’?
Symptoms that cause clinically signifiant distress or impairment in social, occupational, or other areas in life
What characterises the ‘Brief Limited Intermittent Psychotic Symptoms’?
Short-lived episode of psychosis
less than 7 days and resolving without use of antipsychotics
What characterises the ‘Genetic Risk and Deterioration Syndrome’?
Having one first-degree relative affected with psychosis, and psychosocial dysfunction
- less frequent than other 2 criteria for ARMS
What happens to individuals that qualify for an ‘at risk mental state’ (Fusar-Poli et al., 2013)?
Active treatment or monitoring
- if transition to psychosis
- > first-episode psychosis treatment
- otherwise: final assessment
- > potential discharge
What is the most frequent intake criterion checked using the CAARMS (Yung et al., 2006)?
Attenuated Psychosis Syndrome (APS)
What characterises CAARMS?
- Semi-structured interview
- Measures severity of attenuated positive psychotic symptoms
- Asks several questions and rates the attenuated positive psychotic symptoms
- Checks for different combinations of severity and frequency of symptoms
What characterises the Attenuated Psychosis Syndrome (APS)?
Presenting with subthreshold, mostly positive, attenuated symptoms
(not severe enough to qualify for psychotic disorder in ICD or DSM)
What are the most frequently reported attenuated psychotic symptoms?
- Feeling that the world around is somehow fake and fabricated
- Feelings of being controlled and spied on
-> at-risk mental state
(not delusional)
What is the difference between prodromal and clinical high risk?
- Prodromal definition
- > retrospective view
- Clinical High Risk definition
- > Prospective view
What are the key differences between the DSM-5 Attenuated Psychosis Syndrome (APS) and the Psychosis Risk State (Clinical High Risk State)?
- DSM-5 only looks at individuals presenting mild and attenuated positive psychotic symptoms (CAARMS inclusion criteria)
BUT does not include the BLIP or GRD groups - Distress and disability are key entry criteria to meet DSM-5 APS
BUT not strictly needed to meet Clinical High Risk State for psychosis
What is the BLIP?
Brief Limited Intermittent Psychotic Symptoms
What is the GRD?
Genetic Risk and Deterioration Syndrome
What is the impact of conceiving psychosis as either a risk status disorder or a risk factor?
Clinical relevance because the choice impacts on the treatments offered
If the Clinical High Risk State for psychosis is considered equivalent to a hypercholesterolemia, how is psychosis conceived?
Hypercholesterolemia: asymptomatic medical condition
- risk of major cardiovascular events
GP’s prescription: benign treatments
-> psychosis = risk factor
If the Clinical High Risk State for psychosis is considered equivalent to an angina, how is psychosis conceived?
Angina: cardiovascular condition associated with symptoms at baseline
GP’s prescription: additional exams and more intensive treatments
-> psychosis = risk status disorder at baseline
What did the meta-analysis of Fusar-Poli and colleagues (2015) of the functional level of individuals at Clinical High Risk for psychosis show?
Functional level of individuals at Clinical High Risk for Psychosis is
- lower compared to healthy controls
- similar to people with psychosis, social phobia, body dismorphic disorder, MDD
- lower then people with bipolar disorder
- > At functional level, individuals at Clinical High Risk for psychosis are comparable to other mental disorders
