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Psychology & Neuroscience of Psychosis > Predicting the transition to psychosis > Flashcards

Predicting the transition to psychosis Flashcards

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1
Q

What was Maudsley’s view on preventing psychosis (1909)?

A

“early treatment… will prevent the necessity… of placing some patients in a lunatic asylum”

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2
Q

What did the ‘ABC’ first episode study of Häfner and Nowotny (1995) show?

A

Prodromal symptoms: which precede the onset of first episode psychosis

  • term adopted in retrospective view: not clinically suitable as way of altering and intervening on the longitudinal development of the illness
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3
Q

What is the problem of retrospective research on the first onset of psychosis?

A

No way to change the course of psychosis

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4
Q

What is the goal of prospective intervention on the transition to psychosis?

A

Being able to identify individuals who will later develop psychosis within samples at clinical high risk

-> intervening prospectively

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5
Q

What characterises the major advancement in knowledge on prodromal psychosis over the past 20 years (Fusar-Poli et al., 2013)?

A

Exponential growing interest in research in clinical literature
- indexing our ability to prospectively identify individuals at clinical high risk of develop psychosis

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6
Q

What are the conflicting findings within the exponential and growing research on the prospective intervention on psychosis development?

A

Confusion regarding the different psychometric tools currently available to prospectively identify individuals at high risk of developing psychosis

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7
Q

What is the use of CAARMS?

A

Check for different inclusion criteria for individuals at high risk state for psychosis

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8
Q

What are the three inclusion criteria to qualify for an ‘at risk mental state’ in CAARMS (Fusar-Poli et al., 2013)?

A
  1. Attenuated Psychosis Syndrome
  2. Brief Limited Intermittent Psychotic Symptoms
  3. Genetic Risk and Deterioration Syndrome
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9
Q

What characterises the ‘Attenuated Psychosis Syndrome’?

A

Symptoms that cause clinically signifiant distress or impairment in social, occupational, or other areas in life

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10
Q

What characterises the ‘Brief Limited Intermittent Psychotic Symptoms’?

A

Short-lived episode of psychosis

less than 7 days and resolving without use of antipsychotics

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11
Q

What characterises the ‘Genetic Risk and Deterioration Syndrome’?

A

Having one first-degree relative affected with psychosis, and psychosocial dysfunction

  • less frequent than other 2 criteria for ARMS
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12
Q

What happens to individuals that qualify for an ‘at risk mental state’ (Fusar-Poli et al., 2013)?

A

Active treatment or monitoring

  • if transition to psychosis
  • > first-episode psychosis treatment
  • otherwise: final assessment
  • > potential discharge
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13
Q

What is the most frequent intake criterion checked using the CAARMS (Yung et al., 2006)?

A

Attenuated Psychosis Syndrome (APS)

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14
Q

What characterises CAARMS?

A
  • Semi-structured interview
  • Measures severity of attenuated positive psychotic symptoms
  • Asks several questions and rates the attenuated positive psychotic symptoms
  • Checks for different combinations of severity and frequency of symptoms
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15
Q

What characterises the Attenuated Psychosis Syndrome (APS)?

A

Presenting with subthreshold, mostly positive, attenuated symptoms
(not severe enough to qualify for psychotic disorder in ICD or DSM)

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16
Q

What are the most frequently reported attenuated psychotic symptoms?

A
  • Feeling that the world around is somehow fake and fabricated
  • Feelings of being controlled and spied on

-> at-risk mental state
(not delusional)

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17
Q

What is the difference between prodromal and clinical high risk?

A
  • Prodromal definition
  • > retrospective view
  • Clinical High Risk definition
  • > Prospective view
18
Q

What are the key differences between the DSM-5 Attenuated Psychosis Syndrome (APS) and the Psychosis Risk State (Clinical High Risk State)?

A
  1. DSM-5 only looks at individuals presenting mild and attenuated positive psychotic symptoms (CAARMS inclusion criteria)
    BUT does not include the BLIP or GRD groups
  2. Distress and disability are key entry criteria to meet DSM-5 APS
    BUT not strictly needed to meet Clinical High Risk State for psychosis
19
Q

What is the BLIP?

A

Brief Limited Intermittent Psychotic Symptoms

20
Q

What is the GRD?

A

Genetic Risk and Deterioration Syndrome

21
Q

What is the impact of conceiving psychosis as either a risk status disorder or a risk factor?

A

Clinical relevance because the choice impacts on the treatments offered

22
Q

If the Clinical High Risk State for psychosis is considered equivalent to a hypercholesterolemia, how is psychosis conceived?

A

Hypercholesterolemia: asymptomatic medical condition
- risk of major cardiovascular events

GP’s prescription: benign treatments

-> psychosis = risk factor

23
Q

If the Clinical High Risk State for psychosis is considered equivalent to an angina, how is psychosis conceived?

A

Angina: cardiovascular condition associated with symptoms at baseline

GP’s prescription: additional exams and more intensive treatments

-> psychosis = risk status disorder at baseline

24
Q

What did the meta-analysis of Fusar-Poli and colleagues (2015) of the functional level of individuals at Clinical High Risk for psychosis show?

A

Functional level of individuals at Clinical High Risk for Psychosis is
- lower compared to healthy controls

  • similar to people with psychosis, social phobia, body dismorphic disorder, MDD
  • lower then people with bipolar disorder
  • > At functional level, individuals at Clinical High Risk for psychosis are comparable to other mental disorders
25
Q

What would we expect of a psychometric instrument?

A

To achieve both high reliability and validity

26
Q

What is the aimed reliability within CAARMS?

A

Ability to provide converging diagnosis across raters

27
Q

What is the aimed validity within CAARMS?

A

Ability to identify the true positives
(individuals who will develop psychosis at later stage in life)

  • allows us to predict psychosis within relatively short period of time (2-3 years)
28
Q

What characterises the reliability of the psychosis risk state within research settings (Fusar-Poli, Carpenter, Woods and McGlashan, 2014)?

A

Cohen’s kappa, at 0.81

-> very high reliability

29
Q

What is Cohen’s kappa?

A

Statistical measure that indexes proportion of agreement between raters (e.g. using the CAARMS)

30
Q

What is required to have high levels of reliability for the psychometric tools used to identify individuals at Clinical High Risk for psychosis (Fusar-Poli, Carpenter, Woods and McGlashan, 2014?

A

Proper intensive and ongoing training offered to the raters

  • Cohen’s kappa increases between before after training
31
Q

What are the key findings of the meta-analyses on the transition to psychosis risk in 2500 individuals who met the intake criteria for Clinical High Risk state for psychosis?

A
  • 30% of individuals at Clinical High Risk for psychosis will eventually develop psychosis within 2 years
  • Risk of developing psychosis particularly high during first 2 years from initial baseline assessment
  • If transition to psychosis is going to occur, it’s very likely (for at least 50% of individuals) that it will occur within first 8-9 months
  • > Need to intervene very early
32
Q

What can the ability to identify the true positives amongst individuals at Clinical High Risk state comparable to?

A

Comparable to other (preventative) approaches in clinical medicine

33
Q

What did the meta-analysis of Fusa-Poli and colleagues (2013) on the ICD/DSM diagnostic outcomes in transitions to psychosis suggest?

A

The field is heavily biased towards prevention of schizophrenia spectrum disorders

34
Q

What is the recent meta-analytical evidence on the levels of risk to develop psychosis across different subgroups (Fusar-Poli et al., 2016)?

A

Heterogeneity within outcome and the definition of Clinical High Risk state at baseline

  • Clear stratification across the 3 major subgroups after 2 years
  • BLIP subgroup shows very high risk of developing psychosis (higher than those with Attenuated Psychotic Symptoms)
  • Risk presented by those presenting Attenuated Psychotic Symptoms is intermediate, between BLIP and GRD subgroups
35
Q

What are the two competing diagnostic and psychopathological views on the risk to develop psychosis?

A

Operationalisation for short-lived psychotic episodes

  • BLIPS
  • Brief Psychotic Disorder (BPD)

vs

Constructs deriving from international manuals
- Acute and Transient Psychotic Disorders (ATPD)

36
Q

What is the diagnostic significance of BLIPS (as defined under CAARMS) when compared to ICD-10 (Fusar-Poli et al., 2017)?

A
  • 88% of Brief Limited Intermittent Psychotic Symptoms (BLIPS) satisfy the ICD-10 diagnostic criteria for Acute and Transient Psychotic Disorder (ATPD) (F23)
  • strong diagnostic overlap between the BLIPS and ICD-10’s F23 (ATPD) at baseline
37
Q

What did the meta-analysis of Fusar-Poli and colleagues (2016) on the prognostic outcome of competing operationalisation of short-lived psychotic episodes show?

A

The groups (BLIPS, BIPS, ATPD, BPD, FES) are all prognostically equivalent

  • initial diagnosis of first episode schizophrenia is associated with the poorest longitudinal outcomes
38
Q

How was developed the clinical staging of UHR (Ultra High Risk) for psychosis (Fusar-Poli, 2017)?

A

Clinical staging model imported from clinical oncology
- adapted to stratify the different subgroups of Clinical High Risk state for psychosis

-> CHR-P: different subgroups, each associated with specific risk of developing psychosis and specific types of preventative interventions

39
Q

What is the desired outcome of the PSYScan project (2017)?

A

Improve the ability of clinicians to predict the onset of psychosis in individuals meeting Clinical High Risk state for psychosis

40
Q

What is the basis of the PSYScan project (2017)?

A

Prediction algorithm based on wide range of candidate predictors

  • neurobiology
  • psychopathology
  • social demographic

Multi-Parametric Classification

Psychology & Neuroscience of Psychosis (16 decks)

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