Week 4

Question 1

School-based Approaches to Reducing the Duration of Untreated Psychosis

What are the primary symptoms of psychosis?

Answer 1

The primary symptoms of psychosis include delusions, hallucinations, disorganized speech, abnormal psychomotor behavior, and negative symptoms such as avolition and social withdrawal.

Question 2

School-based Approaches to Reducing the Duration of Untreated Psychosis

Why is early intervention important for psychosis?

Answer 2

Early intervention is crucial as shorter durations of untreated psychosis (DUP) are associated with better outcomes, such as improved treatment response, fewer negative symptoms, and reduced mortality.

Question 3

School-based Approaches to Reducing the Duration of Untreated Psychosis

Why are schools important for addressing adolescent psychosis?

Answer 3

Since psychosis often emerges during adolescence when youth are in school, schools can play a pivotal role in early identification, psychoeducation, and reducing the DUP through appropriate interventions.

Question 4

School-based Approaches to Reducing the Duration of Untreated Psychosis

What are some key factors contributing to a longer DUP?

Answer 4

Factors include poor insight, avolition, lack of access to mental health services, stigma, caregiver strain, and inadequate screening and referral systems.

Question 5

School-based Approaches to Reducing the Duration of Untreated Psychosis

How does stigma impact the treatment of psychosis?

Answer 5

Stigma, both public and self-imposed, can delay help-seeking behavior and hinder early identification and treatment, leading to longer DUP and poorer outcomes.

Question 6

School-based Approaches to Reducing the Duration of Untreated Psychosis

What role have school-based interventions played in reducing DUP globally?

Answer 6

Programs like TIPS in Norway and EPIP in Singapore show that school outreach, education campaigns, and accessible mental health services can significantly reduce DUP and improve outcomes.

Question 7

School-based Approaches to Reducing the Duration of Untreated Psychosis

What are the potential benefits of reducing stigma through schools?

Answer 7

Reducing stigma in schools can create a more inclusive environment, encourage early help-seeking, and educate the community about mental health, thereby facilitating timely intervention.

Question 8

School-based Approaches to Reducing the Duration of Untreated Psychosis

What strategies can schools use to improve psychosis identification?

Answer 8

Schools can employ standardized mental health screening tools, provide psychoeducation, and train staff to recognize early signs of psychosis and make appropriate referrals.

Question 9

School-based Approaches to Reducing the Duration of Untreated Psychosis

What treatments are recommended for students with psychosis?

Answer 9

Recommended treatments include psychopharmacological interventions, psychosocial support, individualized education plans, and addressing comorbid conditions through a multidisciplinary approach.

Question 10

School-based Approaches to Reducing the Duration of Untreated Psychosis

What are some future directions for school-based efforts to reduce DUP?

Answer 10

Future research should focus on improving psychoeducational programs, standardizing definitions and measurements of DUP, enhancing screening tools, and increasing access to specialized mental health care.

Question 11

School-based Approaches to Reducing the Duration of Untreated Psychosis

What developmental milestones are at risk for disruption during adolescent psychosis?

Answer 11

Completing high school, advancing to college, acquiring life skills, maintaining social relationships, and achieving professional or intimate connections.

Question 12

School-based Approaches to Reducing the Duration of Untreated Psychosis

What is the definition of Duration of Untreated Psychosis (DUP)?

Answer 12

DUP is the time between the onset of psychotic symptoms and the initiation of appropriate treatment.

Question 13

School-based Approaches to Reducing the Duration of Untreated Psychosis

Why is reducing DUP crucial for adolescents?

Answer 13

Shorter DUP is linked to better responses to treatment, higher quality of life, fewer negative symptoms, and reduced mortality.

Question 14

School-based Approaches to Reducing the Duration of Untreated Psychosis

What are some disorders that may present with psychotic features?

Answer 14

Schizophrenia, schizoaffective disorder, delusional disorder, mood disorders, substance use, trauma, dementia, and certain medical or sleep conditions.

Question 15

School-based Approaches to Reducing the Duration of Untreated Psychosis

What factors may lead to a longer DUP in adolescents?

Answer 15

Poor insight, stigma, logistical barriers to accessing mental health care, and lack of knowledge about psychotic symptoms among school personnel and families.

Question 16

School-based Approaches to Reducing the Duration of Untreated Psychosis

How can schools reduce stigma associated with psychosis?

Answer 16

By implementing psychoeducation programs, creating a supportive school climate, and engaging students in discussions about mental health.

Question 17

School-based Approaches to Reducing the Duration of Untreated Psychosis

What are examples of international programs aimed at reducing DUP?

Answer 17

TIPS (Norway), EPPIC (Australia), PEPP (Canada), and EPIP (Singapore) have employed strategies such as public education, school visits, and improved access to mental health services.

Question 18

School-based Approaches to Reducing the Duration of Untreated Psychosis

What is one key finding from the TIPS program in Norway?

Answer 18

It significantly reduced DUP from 16 weeks to 5 weeks through early detection and education initiatives.

Question 19

School-based Approaches to Reducing the Duration of Untreated Psychosis

How did the EPIP program in Singapore reduce DUP?

Answer 19

By using mass media, public forums, and school workshops to raise awareness and provide resources, reducing the median DUP from 12 months to 4 months.

Question 20

School-based Approaches to Reducing the Duration of Untreated Psychosis

What are some recommended elements of psychoeducation to reduce psychosis stigma?

Answer 20

Youth-focused, discussion-oriented programs involving personal stories, tangible referral resources, and regular meetings.

Question 21

School-based Approaches to Reducing the Duration of Untreated Psychosis

What role can behavioral assessment tools play in identifying psychosis?

Answer 21

Tools like the Behavioral Assessment Scale for Children (BASC-2) can screen for symptoms of psychosis and link students to specialized care.

Question 22

School-based Approaches to Reducing the Duration of Untreated Psychosis

What are key treatment strategies for psychosis in students?

Answer 22

Psychopharmacological treatment, psychosocial interventions, and individualized educational accommodations.

Question 23

School-based Approaches to Reducing the Duration of Untreated Psychosis

How can schools support families of students with psychosis?

Answer 23

By providing psychoeducation, reducing stigma, and assisting families in accessing mental health resources.

Question 24

School-based Approaches to Reducing the Duration of Untreated Psychosis

What is a clinical vignette’s role in highlighting psychosis identification?

Answer 24

It demonstrates real-world scenarios of how delayed recognition of psychosis impacts students and emphasizes the importance of school-based intervention programs.

Question 25

**Predicting Psychosis** What is the main context of the study on predicting psychosis?

Answer 25

A substantial proportion of people at clinical high risk of psychosis will develop a psychotic disorder over time, but the risk of transition varies between centers and may be declining.

Question 26

**Predicting Psychosis** What was the objective of the study?

Answer 26

To quantitatively examine the literature on transition risk to psychosis in individuals at clinical high risk.

Question 27

**Predicting Psychosis** What data sources were used in the study?

Answer 27

Electronic databases were searched until January 2011, and all studies reporting transition risks in patients at clinical high risk were retrieved.

Question 28

**Predicting Psychosis** How many studies were selected for analysis?

Answer 28

Twenty-seven studies met the inclusion criteria, comprising a total of 2502 patients.

Question 29

**Predicting Psychosis** What was the risk of transition to psychosis over different time periods?

Answer 29

The transition risk was 18% after 6 months, 22% after 1 year, 29% after 2 years, and 36% after 3 years.

Question 30

**Predicting Psychosis** What factors influenced the transition risk to psychosis?

Answer 30

Age of participants, publication year, treatments received, and diagnostic criteria used.

Question 31

**Predicting Psychosis** What conclusion did the study reach about clinical high-risk individuals?

Answer 31

Clinical high-risk individuals have a high risk of developing psychosis within three years, with the risk increasing over time.

Question 32

**Predicting Psychosis** What was the historical approach to managing psychosis?

Answer 32

Psychotic disorders were typically managed only after the first episode of frank psychosis, with little attention given to the period preceding it.

Question 33

**Predicting Psychosis** What are the criteria for identifying individuals at high risk of psychosis?

Answer 33

The criteria include attenuated psychotic symptoms, brief full-blown psychotic episodes, or significant functional decline with genetic risk for schizophrenia.

Question 34

**Predicting Psychosis** What structural and functional brain impairments are associated with high-risk individuals?

Answer 34

Impairments in neuropsychological performance, brain structure, function, connectivity, and neurochemistry.

Question 35

**Predicting Psychosis** Why is the predictive validity of the high-risk state debated?

Answer 35

Because transition risks vary across studies and some recent findings suggest a decline in transition rates.

Question 36

**Predicting Psychosis** What effect did treatment have on transition risk?

Answer 36

Patients receiving psychological treatment had lower transition risks (24.9%) compared to those receiving standard psychiatric care (32.8%).

Question 37

**Predicting Psychosis** How did the transition risk vary by age?

Answer 37

Older individuals had a slightly higher transition risk compared to younger ones.

Question 38

**Predicting Psychosis** What impact did the year of publication have on transition risk?

Answer 38

More recent studies showed a decrease in transition risks, possibly due to earlier detection and intervention.

Question 39

**Predicting Psychosis** What was a major limitation identified in the study?

Answer 39

There is no standardized method for assessing and defining high-risk states or transition to psychosis across studies.

Question 40

**Predicting Psychosis** What was one of the key recommendations for future research?

Answer 40

Future studies should standardize criteria for high-risk states and transition definitions to improve comparability.

Question 41

**Preventive interventions for individuals at ultra high risk for psychosis** What is the purpose of the ultra-high risk (UHR) criteria developed in the early 1990s?

Answer 41

The UHR criteria were developed as part of an early intervention approach to detect individuals at high and imminent risk of developing first-episode psychosis (FEP).

Question 42

**Preventive interventions for individuals at ultra high risk for psychosis** How has the rate of transition to psychosis in UHR samples changed over time?

Answer 42

It has declined from an initial level of 40% to an estimated 22% over the medium term.

Question 43

**Preventive interventions for individuals at ultra high risk for psychosis** What are some of the risks for individuals who do not develop sustained psychosis?

Answer 43

They remain at risk for persistent attenuated positive and negative psychotic symptoms, non-psychotic disorders (notably anxiety and depression), and impaired psychosocial functioning.

Question 44

**Preventive interventions for individuals at ultra high risk for psychosis** What is the primary outcome measured in studies of interventions for UHR individuals?

Answer 44

The primary outcome is the transition to psychosis at 12 months.

Question 45

**Preventive interventions for individuals at ultra high risk for psychosis** What secondary outcomes are assessed in these studies?

Answer 45

Secondary outcomes include attenuated psychotic symptoms, mania, depression, anxiety, general psychopathology, symptom-related distress, global and social functioning, quality of life, and treatment acceptability.

Question 46

**Preventive interventions for individuals at ultra high risk for psychosis** What methodological quality concerns were identified in the studies analyzed?

Answer 46

Twelve studies (46%) were at risk of bias due to methodological limitations, including small sample sizes, lack of randomization details, and absence of blinding.

Question 47

**Preventive interventions for individuals at ultra high risk for psychosis** What was the overall effect of pharmacological and psychological interventions on transition to psychosis at 12 months?

Answer 47

The risk of transitioning to psychosis was significantly reduced by 43%, favoring the experimental condition.

Question 48

**Preventive interventions for individuals at ultra high risk for psychosis** Which intervention was found to be the most effective at reducing transition rates?

Answer 48

Cognitive Behavioral Therapy (CBT) was the only intervention that significantly reduced transition rates compared to control interventions.

Question 49

**Preventive interventions for individuals at ultra high risk for psychosis** How did risperidone plus CBT perform in preventing transition to psychosis?

Answer 49

It was not significantly effective at 12 months or medium-term follow-up, but showed a significant effect at 6 months.

Question 50

**Preventive interventions for individuals at ultra high risk for psychosis** What was the impact of omega-3 fatty acids on psychosis prevention?

Answer 50

Omega-3 fatty acids did not have a significant effect on transition at any time point.

Question 51

**Preventive interventions for individuals at ultra high risk for psychosis** Were there significant differences in global functioning and quality of life between intervention and control groups?

Answer 51

No significant differences were found at 12 months or at other time points.

Question 52

**Preventive interventions for individuals at ultra high risk for psychosis** Did treatment discontinuation rates differ between experimental and control groups?

Answer 52

No significant differences were found in all-cause treatment discontinuation across interventions.

Question 53

**Preventive interventions for individuals at ultra high risk for psychosis** How much did psychosis incidence decrease at 12 months and 18–48 months?

Answer 53

Psychosis incidence was reduced by 45% at 12 months and by 40% at 18–48 months.

Question 54

**Preventive interventions for individuals at ultra high risk for psychosis** What factors contributed to study heterogeneity in intervention effectiveness?

Answer 54

Factors included sample age, inclusion criteria, and the use of enriched CBT protocols.

Question 55

**Preventive interventions for individuals at ultra high risk for psychosis** How did the enriched CBT protocol differ from standard CBT?

Answer 55

It included education and homework assignments to address cognitive biases, leading to greater effectiveness.

Question 56

**Preventive interventions for individuals at ultra high risk for psychosis** What was the main limitation of the studies included in the meta-analysis?

Answer 56

The studies had wide confidence intervals and some methodological weaknesses, requiring further well-designed trials.

Question 57

**Evidence for Differential Predictive Performance** What is the purpose of self-report screening instruments for emerging psychosis?

Answer 57

To improve early detection efforts by increasing the number of true positives among persons deemed to be at 'clinical high risk' of the disorder.

Question 58

**Evidence for Differential Predictive Performance** What was the objective of the study?

Answer 58

To examine whether a commonly used self-report screening tool for psychosis risk performed equally among black and white youths in its ability to predict clinical high-risk status.

Question 59

**Evidence for Differential Predictive Performance** What methods were used in the study?

Answer 59

Black (N=58) and white (N=50) help-seeking individuals ages 12–25 were assessed with the Prime Screen and the Structured Interview for Psychosis-Risk Syndromes (SIPS). A logistic regression model estimated race differences in the strength of the relation between Prime Screen scores and SIPS-defined risk status.

Question 60

**Evidence for Differential Predictive Performance** What were the results of the study?

Answer 60

Higher Prime Screen scores significantly predicted clinical high-risk status among white (p<.01) but not black participants.

Question 61

**Evidence for Differential Predictive Performance** What did the study conclude?

Answer 61

Consideration of race or ethnicity and associated cultural factors is important when screening for clinical high-risk status. The findings support the need to develop culturally valid early psychosis screening tools.

Question 62

**Evidence for Differential Predictive Performance** Who are individuals at 'clinical high risk' for psychosis?

Answer 62

Those experiencing recent attenuated psychotic syndromes or other indicators of susceptibility during adolescence or young adulthood.

Question 63

**Evidence for Differential Predictive Performance** What is one limitation of psychosis prevention efforts?

Answer 63

False-positive identification of psychosis risk syndromes limits the capacity of psychosis prevention efforts.

Question 64

**Evidence for Differential Predictive Performance** Why might self-report screening tools be useful in identifying psychosis risk?

Answer 64

They can indicate one's probability of meeting high-risk criteria once fully assessed and have strong validity in the prediction of subsequent psychosis.

Question 65

**Evidence for Differential Predictive Performance** What is a major problem with many psychometric instruments?

Answer 65

They lack sensitivity to important cultural factors, which may contribute to sociodemographic health disparities.

Question 66

**Evidence for Differential Predictive Performance** Why is it important to develop culturally valid screening tools for psychosis?

Answer 66

To promote appropriately tailored early intervention efforts and reduce disparities in misdiagnosis and treatment.

Question 67

**False-positives and Clinical Heterogeneity among Youth** What is the primary goal of early detection and prevention of psychosis?

Answer 67

To identify individuals showing early, attenuated manifestations and provide appropriate interventions.

Question 68

**False-positives and Clinical Heterogeneity among Youth** What are some factors that influence whether attenuated psychotic signs are considered risk factors for psychosis?

Answer 68

Clients’ life experiences, cultural background, and co-occurring psychopathology.

Question 69

**False-positives and Clinical Heterogeneity among Youth** What has research shown about individuals identified as being at clinical high-risk (CHR)?

Answer 69

Only about 32% develop a psychotic disorder, but many experience persistent functional impairment and comorbid conditions.

Question 70

**False-positives and Clinical Heterogeneity among Youth** What are some ethical concerns in providing intervention for CHR individuals?

Answer 70

Contextual influences on diagnosis, clinical heterogeneity, consequences of disclosing psychosis-risk, and lack of evidence-based guidelines.

Question 71

**False-positives and Clinical Heterogeneity among Youth** What is a 'false positive' in the context of CHR identification?

Answer 71

An individual classified as at-risk for psychosis who was never actually going to develop the illness.

Question 72

**False-positives and Clinical Heterogeneity among Youth** How can life experiences contribute to false-positive identification?

Answer 72

Childhood adversity and substance abuse can lead to transient psychosis-like experiences that may not indicate true psychosis-risk.

Question 73

**False-positives and Clinical Heterogeneity among Youth** How does referral source impact CHR diagnosis?

Answer 73

Clients referred from early psychosis clinics are more likely to require urgent intervention compared to those referred from general sources.

Question 74

**False-positives and Clinical Heterogeneity among Youth** What cultural factors should be considered in CHR diagnosis?

Answer 74

Ethnic minorities and immigrants may show different symptom presentations, and clinician biases may affect diagnoses.

Question 75

**False-positives and Clinical Heterogeneity among Youth** Why is comorbidity important in CHR diagnosis and treatment?

Answer 75

Most CHR individuals have comorbid disorders, which may require prioritized treatment over psychosis prevention.

Question 76

**False-positives and Clinical Heterogeneity among Youth** What is one of the major challenges in implementing CHR treatment?

Answer 76

Lack of strong evidence supporting psychosocial interventions like CBT for CHR symptoms.

Question 77

**False-positives and Clinical Heterogeneity among Youth** How can disclosure of CHR diagnosis affect clients and families?

Answer 77

It may cause fear, confusion, stigma, and misaligned treatment priorities.

Question 78

**False-positives and Clinical Heterogeneity among Youth** What are some strategies to improve CHR identification and treatment?

Answer 78

Use of brief screeners to reduce false-positives and modular, needs-based treatment approaches.