Predicting psychosis

Question 1

What did Maudsely say regarding early treatment over a hundred years ago?

Answer 1

That it could prevent hospitalisation.

Question 2

What did the ABC study of schizophrenia show us?

Answer 2

That there a period of roughly 5 years where there is a negative set of symptoms before psychosis sets in. Prodromal phase. Then 1 year of increasingly positive symptoms. This is used retrospectively only.

Question 3

What is the concept of intervening prospectively?

Answer 3

Finding high risk populations.

Question 4

What is the issue with the increase in the study of Psychosis?

Answer 4

The large degree of differing instruments for measuring psychosis.

Question 5

What are the three inclusion criteria for at risk individuals to psychosis?

Answer 5

APS: Attenuated Psychosis Syndrome: Symptoms that cause distress.

BLIP: brief limited intermitted Psychotic Symptoms: >7 days of psychotic symptoms

GRDS: Genetic Risk and Deteroation, First degree relative having psychosis.

Question 6

What is the most used criteria in the CAARMS?

Answer 6

APS: Checking severity and frequency and then checking combinations.

Question 7

What is the most common APS?

Answer 7

Truman show, being watched, that the world is a show, but do not reach full psychosis.

Question 8

What are the key differences between the DSM APS and Psychosis Risk State?

Answer 8

It includes only the APS part of the CAARMS? 70%

Distress is more necessary in DSM APS

Concept of psychosis as Risk factor or disorder?

Question 9

What may be one way to determine if Clinical high risk is a risk factor or disorder?

Answer 9

Meta analysis of function, which shows that individuals are much lower than controls and comparable to other Disorders.
Spider diagram

Question 10

How reliable are the measures of Psychosis high risk and what can attenuate it?

Answer 10

Very reliable: Kappa of 0.81-0.89

However if no training this is 0.31 or 0.52

Question 11

How valid is the measures of Psychotic High Risk?

Answer 11

30% accuracy of developing full psychosis in 2 years.

After 3 years less predictable.

8-9 months after first symptoms is the most common period for 50% of those who will develop Psychosis.

Question 12

What types of psychosis will the 30% who are at risk of developing full blown psychosis,

Answer 12

73% Schizophrenia

11% Mood disorders

16%Other

Question 13

Of the three measures of High risk to Psychosis which is the best predictor?

Answer 13

BLIPS
then APS
GRD no better than controls

Question 14

What are the ICD and DSM constructs for criteria of Blips and BIPS?

Answer 14

ICD-10 Acute Transient Psychotic Disorder
DSM-Brief psychotic Disorder

68% BLIPS also meet ATPD criteria.

Question 15

What is PsyScan?

Answer 15

An attempt to use algorithms to predict outcome and treatment options.

Question 16

What is OASIS, who is for and what are the core targets?

Answer 16

Outreach and Support in South London.

15-35 years old
High risk psychotic psymptoms
Help seeking individuals

Core targets:
Reduce symptoms and disability
Prevent transition
Improve outcomes

Question 17

What is the demographics of those who come to OASIS?

Answer 17

3.4% healthy
27.6% First episode
34% Other illness
34.9 % ARMS

Question 18

Where are the majority of referrals from OASIS coming from?

Answer 18

GPs, Community care and first episode team

Question 19

What is the outcomes of those who are taken in by OASIS?

Answer 19

18% pyshcosis
32% Non-psychotic morbid disorders
5% persistent high risk
20% remission

Question 20

Why does the OASIS team have no signs and NHS logos?

Answer 20

Respect privacy

Separate service to NH

this improves accessibility and improves connection with younger demographic

Question 21

What is the evidence for the different therapies in the High risk Group?

Answer 21

CBT effective in early stages.

Experimental and psychotherapy low evidence

Very low evidence for Antipsychotics.

Question 22

What does the evidence tell us about treatment for individuals who are High Risk to Psychosis?

Answer 22

We can delay onset, We cannot maintain benefits indefinitely
We can’t prevent psychosis

No effective treatments for :

APS
Cognitive dysfunction
Function impairments
Negative symptoms

Question 23

What is NNT and what is it’s value in Psychosis, Diabetes and Serious cardiovascular events?

Answer 23

Number needed to treat-

14 psychosis
14 Diabetes
25 SCE

Question 24

What accounts for the difference in mean days of untreated psychosis?

Answer 24

The protective approach of OASIS

Question 25

What is the advantage to the community in using OASIS?

Answer 25

The reduction in administration rate using the MHA?

Question 26

What is the Economic benefit of OASIS?

Answer 26

More costly to set up, however, cheaper per year at roughly £1000 less a year vs TAU