7. Early Intervention and the high-risk paradigm Flashcards
Research suggests:
1. Clinical disorders are present in c____ for most adults who later develop s____ and c____ mental health problems
2. Most diagnosable disorders emerge in adolescence, with approx __% of all lifetime cases emerging by age 14, rising to __% by age 24
3. Only __-__% of young people experiencing difficulties at a clinical level access a____ s____ at a s____ e____ age
- childhood, severe, chronic
- 50%, 75%
- 30-40%, appropriate support, sufficiently early
The lack of appropriate interventions for children and young people may mean:
1. young people are more likely to experience p____ d____ as a consequence of their mental health
2. these mental health difficulties may p____ from childhood into later life
- prospective difficulties
- persist
Preventive interventions are strategies aimed at d____ or p____ the o____ of diagnosable disorders. The aim is to a____ or r____ the associated potential negative h____, e____ and s____ outcomes
delaying, prevention, onset
avoid, reduce, health, economic, social
Universal preventive strategies are designed to be delivered to all individuals within a population of i____, regardless of r____ f____
interest, risk factors
Targeted preventive strategies are designed for individuals experiences r____ f____ associated with:
1. A given d____ (s____ prevention)
2. or who are already experiencing s____-t____ symptoms (i____ prevention)
- risk factors
- disorder, selective
- sub-threshold, indicated
To be effective, a preventive strategy needs to identify which risk factors are both:
1. M____
2. C____ i____ in the development of mental health problems
- Modifiable
- Causally implicated
Schizophrenia has been a key focus of interest for early intervention. It is associated with:
1. Significant p____ and e____ lifetime burned
2. Reduced l____ e____
- personal, economic
- Life expectancy
Psychosis prodrome:
Prodrome refers to the s____/s____ of a disorder that p____ the o____ of the fully d____ disorder.
In psychosis, the prodromal phase is typically characterised by the experience of s____-t____ psychotic symptoms and a decrease in s____-o____ functioning
symptoms/signs, precede, onset, developed
sub-threshold, socio-occupational
Research suggests that specialised early intervention serves are more effective than s____ c____ for improving outcomes of both p____ and n____ symptoms, and g____ f____ in psychosis.
standard care, positive, negative, global functioning
researchers have suggested that psychosis may exist on a c____ with everyday experience. The psychosis c____ encompasses a broad range of psychosis symptom experiences from symptoms that are ‘s____’ through to the symptom experiences observed in individuals who have a c____ d____.
continuum, continuum, subclinical, clinical diagnosis
Subclinical psychotic symptoms such a (e.g. p____ i____ can often be distinguished from clinically significant symptoms based on features such as:
1. S____ of the symptoms
2. F____ of the symptoms
3. C____ regarding the symptoms
paranoid ideation
1. Severity
2. Frequency
3. Conviction
The ‘at-risk/ultra-high risk for psychosis’ concept was developed as a consequence of:
1. The success of e____ i____ services
2. The recognition of the p____ p____
3. An understanding of psychosis across a c____ of e____
- early intervention
- prodrome phase
- continuum of experience
The at risk mental states (ARMS) concept, also referred to as chronic high risk (CHR) or ultra-high risk (UHR) for psychosis, was developed to:
1. Identify h____-s____ individuals at e____ r____ of transition to psychosis
2. Design t____ i____ aimed at p____ or d____ the o____ of a f____ episode of psychosis
- help-seeking, elevated risk
- targeted interventions, preventing, delayed, onset, first
Two measures for the high-risk for psychosis paradigm are:
1. C____ A____ of A____-r____ Mental States (CAARMS; Lung et al., 2005)
2. S____ I____ for Psychosis-R____ S____ (SIPS; McGlashan et al., 2010)
- Comprehensive Assessment, At-Risk
- Structured Interview, Risk Syndrome
The Comprehensive Assessment of At-Risk Mental States (CAARMS) (Yung et al., 2005) is a s____ c____ i____ designed to identify individuals at high risk for t____ to psychosis
standardised clinical interview, transition
The four sub scales of the positive symptoms domain in CAARMS are:
1. U____ Thought Content
2. N____-B____ Ideas
3. Perceptual A____
4. D____ S____
- Unusual Thought Content (e.g. ideas of reference, thought insertion).
- Non-Bizarre Ideas (e.g. suspiciousness, persecutory ideas, grandiose ideas).
- Perceptual Abnormalities (e.g. visual hallucinations, auditory hallucinations).
- Disorganised Speech (rated based on individual’s experience and clinician rating; e.g. difficulties with speech, tangential speech).
There are three at-risk mental states (ARMS) groups:
1. V____ group - either having a s____ personality disorder or a f____ h____ of a f____ d____ relative with a psychotic disorder
2. A____ psychotic symptoms (APS) - a____ positive psychotic symptoms experienced for at least o____ m____ within the p____ y____
3. B____ l____ i____ psychotic symptoms (BLIPS) - positive psychotic symptoms within the p____ y____ that lasted less than o____ w____ and s____ r____ without treatment
All three groups also need A significant d____ in f____ OR c____ l____ f____ to meet ARMS criteria.
- Vulnerability group: either having a schizotypal personality disorder or family history of first degree relative with a psychotic disorder.
- Attenuated Psychotic Symptoms (APS): attenuated (sub-threshold intensity or frequency) positive psychotic symptoms experienced for at least one month within the past year.
- Brief Limited Intermittent Psychotic Symptoms (BLIPS): positive psychotic symptoms within the past year that lasted less than one week and spontaneously remitted without treatment.
Drop, functioning, chronic low functioning
Characteristics of at-risk individuals - symptoms:
1. Comorbidity
- High comorbidity among at-risk individuals… 69-78% meeting at-risk criteria also meet at least one other n____-p____ diagnosis
2. Symptomatology
- Studies found, compared to clinical h____-s____ individuals, individuals meeting ARMS criteria experience
a) higher levels of a____ and s____ a____
b) higher levels of a____-s____ symptoms of d____
3. Hopelessness and suicidality
- adolescents meeting at-risk criteria significantly h____ levels of hopelessness as compared to clinical h____-s____ adolescents
- suicidal i____ and s____-h___- are highly prevalent among young people meeting at-risk criteria
- Compared to a non-at-risk clinical group, c____ suicidality was higher among individuals at risk for psychosis, although the two groups did not differ with regard to l____ suicidality
non-psychotic
help-seeking
anxiety, social anxiety
affective-somatic, depression
higher, help-seeking
ideation, self-harm
current, lifetime
Characteristics of at-risk individuals - functioning:
Compared to mental health service users without evaluated psychosis risk, being at risk for psychosis is associated with:
1. Reduced g____ f____
2. Reduced s____ c____ and c____
3. However, rates of e____/e____ were not significantly different t between groups
- global (social and role) functioning
- social contact, communication
- employment/education
Characteristics of at-risk individuals - cognition:
1. Schemas
- D____ cognitive b____ - include how an individual p____ both t____ and o____
- Considered to develop as a consequence of r____ with significant others
- M____ schemas considered to develop as a consequence of a____ e____ in c____
- Deeper, beliefs, perceives, themselves, others
- relationships
- Maladaptive, adverse experiences, childhood (e.g. abuse, neglect)
Maladaptive schemas are significantly higher in a____-r____ groups as compared to non-clinical controls. Individuals meeting ARMS criteria endorse similarly n____ and p____ beliefs about s____ and o____ as compared to individuals who have experienced a first episode of psychosis
at-risk
negative, positive, self, others
Emerging evidence regarding schematic beliefs in high-risk groups as compared to other clinical, non-psychosis groups:
1. Some evidence schematic beliefs do not differ for pts meeting ARMS criteria as compared to h____-s____, c____ group (who did not meet ARMS criteria)
2. Other research found pts meeting ARMS criteria endorsed significantly more m____ s____ as compared to a h____-s____, c____ group
- help-seeking, clinical
- maladaptive schemas, help-seeking, clinical
A cognitive model of paranoia:
Involve themes of p____, t____ and h____. Paranoia is one of the most commonly experienced p____ symptoms.
Paranoid thoughts are common amongst both c____ and n____-c____ populations.
Paranoia is associated with:
1. D____ and poor f____ outcomes
2. More m____ c____ strategies
Persecution, threat, harm
positive
clinical, non-clinical
1. Distress, functional
2. Maladaptive coping
Crowter et al.’s (2022) secondary analysis on data from the PRODIGY trial (Fowler et al., 2017) revealed no significant difference in f____ m____ f____ between the ARMS and non-ARMS groups, suggesting that the processes u____ paranoia did not d____ as a function of ARMS status
final model fit, underlying, differ
Conclusions from Crowter et al. (2022):
1. Symptoms of d____ and s____ a____ were higher for pts meeting at-risk criteria for psychosis as compared to a clinical, non-ARMS group
- ARMS pts endorsed significantly more m____ s____ than the non-ARMS group
- When examining the relationships between schemas, affective symptoms and paranoia:
- negative-s____ and negative-o____ schemas were directly associated with p____
- negative-s____ schemas were predictive of s____ a____
- both negative-s____ and negative-o____ schemas were predictive of greater levels of d____ - There was no significant different in f____ m____ f____ between groups… while the ARMS group may be experiencing more m____ schemas, greater n____ a____ and greater p____, the m____ underlying the relationships between these variables seem to be s____ for the non-ARMS clinical group
- depression, social anxiety
- maladaptive schemas
- self, other, paranoia
self, social anxiety
self, other, depression - final model fit, maladaptive, negative affect, paranoia, mechanisms, similar
Implications for treatment from Crowter et al. (2022):
1. The experience of p____ may be a key area of support for young people with emerging complex mental health problems, r____ of whether they meet at-risk criteria
2. Negative-s____ and negative-o____ s____ appear to be a potential t____ t____ for paranoia
3. Young people experiencing b____ clinical high r____ (i.e. non-psychosis r____) are also experiencing significant d____
- paranoia, regardless
- self, other schemas, therapeutic target
- broader, risk, risk, difficulties
Yung et al. (2004):
- 104 participants (mean age 19 years) who met criteria for ARMS (either vulnerability, APS or BLIPS).
- 27% of sample developed psychosis at 6 months, rising to 35% by 12 months. The authors compared those who had transitioned to psychosis at these timepoints with those who had not.
- Findings:
Those who transitioned at 6 and 12 months (as compared to those who did not transition):
1. Had experienced psychiatric symptoms for a significantly l____ p____ of t____
2. Had significantly poorer g____ (s____ and o____) functioning at baseline
3. Had significantly higher levels of d____ at baseline
4. Had significantly poorer a____
- longer period of time
- global (social and occupational)
- depression
- attention
(The groups did not significantly differ on levels of anxiety, mania symptoms, other negative symptoms or cannabis use at baseline)
Cornblatt et al. (2015) found the following were predictors of transition to psychosis:
1. D____ c____
2. S____
3. V____ m____ deficits
4. D____ s____ functioning
When these four variables were combined, there was a significant improvement in the a____ of predicting transition to psychosis (Using the SIPS high-risk criteria, the rate of transition was 28.3%. Using the expanded predictor profile, the accuracy of prediction was 81.8%)
- Disorganised communication
- Suspiciousness
- Verbal memory
- Declining social
accuracy
Research suggests that the implementation of specialist services for individuals at high-risk of psychosis have been beneficial:
1. Specialised services have been found to be c____-e____ in the long-term
2. For those who progress to experiencing a first episode of psychosis (FEP), prior engagement with ARMS services was associated with
a) Shorter d____ of u____ psychosis (DUP)
b) reduced likelihood of h____ a____
c) reduced likelihood of c____ h____ a____
- cost-effective
a) duration, untreated
b) hospital admission
c) compulsory hospital admission
(Shorter DUP is associated with better prognosis)
Main findings for Mei et al. (2021):
1. Pooling results across all studies, the risk of transitioning to psychosis at 12 months was significantly reduced by __% for those who received an intervention (as compared to the control groups)
2. When looking at individual interventions, only C____ appeared to be more effective at reducing the risk of transition at 12 months
3. Interventions were associated with significantly lower a____ p____ s____ at 12 months as compared to control groups
4. There were no significant differences between groups with regard to other symptom outcomes, d____, g____ functioning, s____ functioning, quality of life or treatment a____
- 43%
- CBT
- attenuated positive symptoms
- distress, global, social, acceptability
By definition, the prodrome is a r____ concept. It can only be considered the prodromal phase once someone has e____ psychosis.
retrospective
experienced
