Predicting psychosis Flashcards
What did Maudsely say regarding early treatment over a hundred years ago?
That it could prevent hospitalisation.
What did the ABC study of schizophrenia show us?
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.
What is the concept of intervening prospectively?
Finding high risk populations.
What is the issue with the increase in the study of Psychosis?
The large degree of differing instruments for measuring psychosis.
What are the three inclusion criteria for at risk individuals to psychosis?
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.
What is the most used criteria in the CAARMS?
APS: Checking severity and frequency and then checking combinations.
What is the most common APS?
Truman show, being watched, that the world is a show, but do not reach full psychosis.
What are the key differences between the DSM APS and Psychosis Risk State?
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?
What may be one way to determine if Clinical high risk is a risk factor or disorder?
Meta analysis of function, which shows that individuals are much lower than controls and comparable to other Disorders.
Spider diagram
How reliable are the measures of Psychosis high risk and what can attenuate it?
Very reliable: Kappa of 0.81-0.89
However if no training this is 0.31 or 0.52
How valid is the measures of Psychotic High Risk?
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.
What types of psychosis will the 30% who are at risk of developing full blown psychosis,
73% Schizophrenia
11% Mood disorders
16%Other
Of the three measures of High risk to Psychosis which is the best predictor?
BLIPS
then APS
GRD no better than controls
What are the ICD and DSM constructs for criteria of Blips and BIPS?
ICD-10 Acute Transient Psychotic Disorder
DSM-Brief psychotic Disorder
68% BLIPS also meet ATPD criteria.
What is PsyScan?
An attempt to use algorithms to predict outcome and treatment options.
What is OASIS, who is for and what are the core targets?
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
What is the demographics of those who come to OASIS?
3.4% healthy
27.6% First episode
34% Other illness
34.9 % ARMS
Where are the majority of referrals from OASIS coming from?
GPs, Community care and first episode team
What is the outcomes of those who are taken in by OASIS?
18% pyshcosis
32% Non-psychotic morbid disorders
5% persistent high risk
20% remission
Why does the OASIS team have no signs and NHS logos?
Respect privacy
Separate service to NH
this improves accessibility and improves connection with younger demographic
What is the evidence for the different therapies in the High risk Group?
CBT effective in early stages.
Experimental and psychotherapy low evidence
Very low evidence for Antipsychotics.
What does the evidence tell us about treatment for individuals who are High Risk to Psychosis?
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
What is NNT and what is it’s value in Psychosis, Diabetes and Serious cardiovascular events?
Number needed to treat-
14 psychosis
14 Diabetes
25 SCE
What accounts for the difference in mean days of untreated psychosis?
The protective approach of OASIS
What is the advantage to the community in using OASIS?
The reduction in administration rate using the MHA?
What is the Economic benefit of OASIS?
More costly to set up, however, cheaper per year at roughly £1000 less a year vs TAU
