Can we prevent psychosis onset?

Question 1

What does EI do?

Answer 1

Early intervention aims at remediating existing mental health problems or preventing their occurrence.

It can focus on the individual alone or on the individual and the family together

There are services focusing on early detection and intrevention- they would be working with prodrome

Question 2

Early detection

Answer 2

Picking ppl who are “at risk” for a MH issues before they develop it

Question 3

Primary intervention

Answer 3

Primary intervention- adressing the root casue of the disease (e.g. taking folloc acid in pregnancy)

Question 4

Secondary intervention

Answer 4

Secondary intervention- aims to detect and treat a disease early on to prevent it from getting worse

Question 5

Tertriaty intervention

Answer 5

Aims at preventing long term disablity from a disorder

Question 6

Primary indication prevention

Answer 6

Ppl don’t have yet the secondary intervention b.c. they dont have psychosis yet

Question 7

What symptoms are there for the 1a and 1b stages (staging model), before FEP?

Answer 7

*Mild or non-specific symptoms of
psychotic disorder
*Mild functional change or decline

Intervention: Stabilisation/natural remission very likely
→ Inform, normalise

AND

“At Risk Mental State” (ARMS)
*Moderate but sub-threshold symptoms
*Functional decline
*Distressed & help seeking
*Moderate neurocognitive changes

Intervention:
Increased risk of psychosis, but stabilisation/remission possible
→Inform, normalise, monitor carefully
→Treat current symptoms

Question 8

Who is in the early ARMS (at risk state)?

Answer 8

BS - basic symptom criterion people
Functional state- biological trait criteria

Question 9

Who is in the late ARS (at risk state)?

Answer 9

Attenuated Psychosis Symptoms
BLIP (brief, limited intemitted, psychotic episode)

Question 10

Criteria for an ‘at risk mental state’ ARMS

Answer 10

Tested with Comprehensive Assessment of At Risk Mental States (CAARMS) (Yung et al. 2005)

1. Attenuated psychotic symptoms
2. Transient psychotic symptoms (BLIP)
3. Trait vulnerability plus decline in function
4. Age 14-35

Question 11

Attenuates psychotic group

Answer 11

○ Can be measures by asking ppl how sure they are about some of thier symptoms (e.g. dillusions and CIA etc)
○ Last 1 year
○ Detirioration in their functioning
○ Symptoms which do not reach threshold levels for psychosis due to sub-threshold intensity (the symptoms are not severe enough)
○ Or they have psychotic symptoms but at a sub-threshold frequency (the symptoms do not occur often enough).

Question 12

Vounrability group for psychosis

Answer 12

Family history in 1st degree relative
Schizotypical Personlaity Disorder
Change in affect
Paranoid idelations
Few friends, people they trust
Social anxiety
Paranoid fears
Ect

Question 13

BLIP group

Answer 13

A recent history of frank psychotic symptoms which resolved spontaneously (without antipsychotic medication)
within one week.

Symptoms occurred during the last year

Question 14

What is risk enrichment?

Answer 14

When you reqruite/ test people from a group where you are likely to observe a phenomenon

e.g. if you want to develop blood test for diabetis, you will not look for participants at a gym (low risk enrichment) but at a diabetis clinique (high risk enrichment)

Question 15

Which ARMS group is most likelt to transiton?

Answer 15

Fusar-Poli et al. (2016)
BLIP>ARS>GRD (genetic risk)= CHR- (not at risk for psychosis= HC)

• For BLIPS the risk is highest but after around 2 years it reacher a plato (3,4+ years)
  
  • Ppl in this group can often be difficult to engage becasue after the incident it “goes back to normal” – the level of insight varies becasue the issues goes away fast, so its hard to get them in the clinic BUT we want that becasue they are at the highest risk
• Genetically, there is not much difference between GRD and CHR-

CRITIQUE:

1. It could be due to changes to pre-test risk enrichment over time (which individuals are selected to have UHR assessment)
2. (Fusar-Poli et al., 2012) Meta-regression of year of publication showed a modest but significant effect toward reduced transition rates for the most recently published studies

Question 16

Advantages of pre-psychotic intervention

Answer 16

1. Providing intervention to help-seeking and symptomatic group, whether or not transition occurs.
2. Clients easier to engage
3. If psychosis develops, DUP minimised and crises / hospitalisation avoided.
4. Potential to reduce overall costs of care.
5. Evidence-based treatments

Question 17

Disadvantagues of pre-psychotic intervention

Answer 17

1. Can be stigmatising or even harming patients with treatment, particularly false positives. (treating people who wouldn’t develop psychosis anyway) + waste of resources
2. Pharmacological intervention: side effects, risk of obesity and diabetes.
3. Impact of being labelled “at risk for psychosis” – self-imposed stigma, restriction on life goals, fear of illness, reaction of family.
4. Confidentiality: medical records, insurance, employers.

Question 18

What treatment works for UHR?

Answer 18

1. Some evidence for antipsychotics BUT the costs might not outweight benefits + NICE advice against that
2. OMEGA-3
3. CBTp

BUT mixed findings e.g. Devoe et al., 2018a- no effect for APS

Question 19

What is OASIS?

Answer 19

Outreach service for people (14-35 years old) with ‘at risk’ symptoms
Help-seeking
Primary Care setting
Aims to:
◦ Reduce presenting symptoms and disability
◦ Prevent transition to psychosis
◦ Improve outcome if psychosis develops
Quick response (within 1 week)

Work closely with FEP teams when necessary
If At Risk we see client for 2 years, clients can choose from:
◦ Psychological Intervention (Cognitive Behaviour Therapy,CBT, family therapy)
◦ Advice on medication
◦ Case management: Information, practical advice and assistance (eg housing, benefits)
If NOT At Risk referred on to most appropriate service or back to GP