Abstract
Objectives: Most individuals experience a relatively long period of sub-clinical psychotic like symptoms, known as the ultra high risk (UHR) or at risk mental states (ARMS), prior to a first episode of psychosis. Approximately 95% of individuals who will later develop psychosis are not referred to specialized clinical services and assessed during the UHR phase. The study aimed to investigate whether a systematic early detection program, modeled after the successful early detection of psychosis program TIPS, would improve the detection of help-seeking UHR individuals. The secondary aim was to examine the rates and predictors of conversion to psychosis after 2 years.Method: The overall study design was a prospective (2012–2018), follow- up study of individuals fulfilling UHR inclusion criteria as assessed by the structural interview for prodromal syndromes (SIPS). Help-seeking UHR individuals were recruited through systematic early detection strategies in a Norwegian catchment area and treated in the public mental health services.Results: In the study period 141 UHR help-seeking individuals were identified. This averages an incidence of 7 per 100,000 people per year. The baseline assessment was completed by 99 of these and the 2 year psychosis conversion rate was 20%. A linear mixed-model regression analysis found that the significant predictors of conversion were the course of positive (0.038) and negative symptoms (0.017). Age was also a significant predictor and showed an interaction with female gender (<0.000).Conclusion: We managed to detect a proportion of UHR individuals in the upper range of the expected prediction by the population statistics and further case enrichment would improve this rate. Negative symptoms were significant predictors. As a risk factor for adverse functional outcomes and social marginalization, this could offer opportunities for earlier psychosocial intervention.
Highlights
The onset of psychosis can be devastating and typically occurs in late adolescence or early adulthood [1]
After initial screening the detection team (DT) assessed 1,510 individuals either by PANSS or Structured Interview for Prodromal Syndromes (SIPS) and assigned to the first episode of psychosis (FEP) TIPS2 study or the Prevention of Psychosis study (POP) ultra high risk (UHR) study based on eligibility
The early detection strategies employed were not able to detect UHR cases to the extent predicted by the population statistics and further case enrichment appears to be needed to improve this
Summary
The onset of psychosis can be devastating and typically occurs in late adolescence or early adulthood [1] This is a critical developmental stage for relationships, education and employment, and illness onset can threaten the potential for a productive, inclusive, and fulfilling adult life. A UHR state is usually defined as meeting criteria for one or more of three syndromes: the attenuated positive symptoms (APS) syndrome, the brief limited intermittent psychotic symptoms (BLIPS) syndrome, or the genetic risk and/or the deterioration (GRD) syndrome [10] These syndromes are assessed by validated measures, such as the Comprehensive Assessment of At-Risk Mental States (CAARMS) [11] or the Structured Interview for Prodromal Syndromes (SIPS) [7]. In the fifth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM 5), APS was included as a condition for further study [12]
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