Lecture 3: Prodrome, Early Detection of UHR and Risks

Question 1

Name 3 widely uses intruments

Answer 1

SPI-A
Schixophrenia Proness Instrument - Adult Version

CAARMS
Community Assessment of At Risk Mental State

SIPS/SOPS
Schizophrenia Interview for Prodromal Symptoms
Schizophrenia Scale of Prodromal Symptoms

Question 2

What was the SPI-A designed to primarily support?

Answer 2

The prediction of first episode psychosis

Question 3

What are the rating areas of the SPI-A (7)

Answer 3

Affectve-dynamic distrubances (Impaired tolerance for certain stressors)
Cognitive attentional impediments
Cogtnitive Disturbances
Disturbances in experiencing self and surroundings
Body perception disturbances
Percetion Disturbances
Optional Additional Items

Question 4

When is a symptom a symptom according to SPI-A?

Answer 4

must ONLY be subjectively experienced
scored ehrn symptoms experienced as a disturbance deficiency or a complaint IRRESPECTIVE of its appearace in behaviour

induvidual reports but not observed by itnerviewer = RECORD
interviewer observes but induivudal not reported IS NOT recorded by interviewer

Symptoms must reporesent achance from what the person used to be like when they were well

Question 5

How is “at-risk” defined with SPI-A?

what two symptoms measured by SPI-A have shown to predict sympotms of psychosis?
and who’s studies showed them?

Kl_________r et al (2001)

S——-L——- et al (2007)

Answer 5

COPER and COGDIS

COPER 
Cognitive-perceptive basic symptoms: 
-- Thought Inferences 
--Thought Blockages 
-- Disturbance of recetpive speech 
--Decreased abiity to discriminate ideas/fantasies from reality 

Klosterkoetter et al (2001) - very high transition rates for COPER
20% in 12 months
50% after 3 years

COGDIS
Cognitive Disturbances
Schultze-Lutter et al (2007)
24% in 12 months and 61% after 3 years

Question 6

what are problems with COPER/COGDIS prediction?

Answer 6

Problems
Regarded difficult to assess
Pathway to care unclear
can this be used in a clinical setting

Question 7

How does the other measures (CAARMS and SIPS) differ?

Answer 7

THey focused on latter stages more at-risk focus, Ultra High Risk

Question 8

What are CAARMS and SIPS used to detect

what popualtion are CAARMS and SIPS used on?

What are the implications of that?

Answer 8

CAARMS and SIPS are used to detect attenuated/subthreshold symptoms

Person MUST be help-seeking
- not used in GP so dont know PPV and NPV in GP

Person may require a functional impairment
- persisitent low functioning or 30% delcine in last 12 months

Question 9

How do attenuated/subthreshold symptoms differ from frank symptoms

Answer 9

• • these symptoms differ from frank symptoms in intensity, frequency and/or duration
• —- persecutory beleif about someone who is behind you on train you don’t
• —— Hold it fully (intensity)
• —— Hold it for long (duration)
• —— it only happened once (Hz)

Question 10

What are the CAARMS criteria?

Answer 10

Group 1 Attenuated Psychosis
– SUbthreshold Intenisty or Frequency
Group 2 BLIPS Breif Limited Intermittened Psychotic Symptoms
– Full threshold symptoms that last less than a week
Group 3 Vulnerabilty
– 1st degree relative with psychosis OR personal history of schizophrenia, plus a functional decline

Question 11

What are the aims of CAARMS? (3)

Answer 11

UHR
Determine if the induviudal meets UHR criteria

Onset
Rule out or confirm criteria for onset of psychosis (transitioners)

Map
To map over time a range of symptoms found in psychotic prodromes

Question 12

What are the psychometric properties of CAARMS

Answer 12

Inter rate = 0.85
Concurrent = Great 2.08 vs 0.29 (C) scores on CAARMS
Discriminant =
12 month tranistion rate CAARMS = .42 CI 95% 0.26- 0.55
12 month tranistion rate BPRS =.41 CI 95% 0.25-0.53

Sen = .83
Spe=.74
PPV = 0.12
NPV = 0.99

Question 13

7 domains of psychopathology covered by CAARMS

Answer 13

1. Postive symptoms
2. Negative symptoms
3. Cognitive changes (attention/concentration)
4. Behavioural changes
5. General Psychopathology
6. Emotional changes
7. Motor/physical changes

Question 14

Yung et al (2005)

Psychometric properties

Answer 14

Collected data from ORYGEN Youth Health which has UHR clinic (PACE clinic)

CAARMS scores predicted onset of psychosis (-ve symptoms not popstive) - not presence of hallunications or dleusions but negative symptoms

Those mething UHR criteria on the CAARMS had a higher rate of tranistion to psychosis at 6 month follow up