Unmet needs for treatment in 102 individuals with brief and limited intermittent psychotic symptoms (BLIPS): implications for current clinical recommendations.

Paolo Fusar-Poli,Monica Chalambrides,Castagnini Augusto,Aoife Singh,Andrea De Micheli,Philip Mcguire

doi:10.1017/s2045796019000635

Abstract

To investigate clinical outcomes and unmet needs in individuals at Clinical High Risk for Psychosis presenting with Brief and Limited Intermittent Psychotic Symptoms (BLIPS). Prospective naturalistic long-term (up to 9 years) cohort study in individuals meeting BLIPS criteria at the Outreach And Support In South-London (OASIS) up to April 2016. Baseline sociodemographic and clinical characteristics, specific BLIPS features, preventive treatments received and clinical outcomes (psychotic and non-psychotic) were measured. Analyses included Kaplan Meier survival estimates and Cox regression methods. One hundred and two BLIPS individuals were followed up to 9 years. Across BLIPS cases, 35% had an abrupt onset; 32% were associated with acute stress, 45% with lifetime trauma and 20% with concurrent illicit substance use. The vast majority (80%) of BLIPS individuals, despite being systematically offered cognitive behavioural therapy for psychosis, did not fully engage with it and did not receive the minimum effective dose. Only 3% of BLIPS individuals received the appropriate dose of cognitive behavioural therapy. At 4-year follow-up, 52% of the BLIPS individuals developed a psychotic disorder, 34% were admitted to hospital and 16% received a compulsory admission. At 3-year follow-up, 52% of them received an antipsychotic treatment; at 4-year follow-up, 26% of them received an antidepressant treatment. The presence of seriously disorganising and dangerous features was a strong poor prognostic factor. BLIPS individuals display severe clinical outcomes beyond their very high risk of developing psychosis and show poor compliance with preventive cognitive behavioural therapy. BLIPS individuals have severe needs for treatment that are not met by current preventive strategies.

Highlights

Individuals at Clinical High Risk for Psychosis (CHR-P hereafter (Fusar-Poli, 2017)) are detected by specialised clinical services through established psychometric assessment tools (Fusar-Poli et al, 2015a), in the context of a clinical interview (Fusar-Poli et al, 2017c). These tools assess whether the individual is meeting at least one of the three CHR-P subgroups: Attenuated Psychotic Symptoms (APS, about 85% of cases), Genetic Risk and Deterioration Syndrome (GRD, 5% of cases) or Brief and Limited Intermittent Psychotic Symptoms (BLIPS, 10% of cases) (Yung et al, 2005; Fusar-Poli et al, 2016b)
This study aims at unravelling the broader clinical outcomes in individuals experiencing a BLIPS and highlighting their potential unmet needs
We included all CHR-P subjects referred for suspicion of psychosis risk to the Outreach and Support in South London (OASIS) service, South London and Maudsley (SLaM) NHS Foundation Trust (Fusar-Poli et al, 2013), who met a refined version of the BLIPS CAARMS 12/2006 criteria (Yung et al, 2006) up to April 2016

Summary

Introduction

Individuals at Clinical High Risk for Psychosis (CHR-P hereafter (Fusar-Poli, 2017)) are detected by specialised clinical services through established psychometric assessment tools (Fusar-Poli et al, 2015a), in the context of a clinical interview (Fusar-Poli et al, 2017c) These tools assess whether the individual is meeting at least one of the three CHR-P subgroups: Attenuated Psychotic Symptoms (APS, about 85% of cases), Genetic Risk and Deterioration Syndrome (GRD, 5% of cases) or Brief and Limited Intermittent Psychotic Symptoms (BLIPS, 10% of cases) (Yung et al, 2005; Fusar-Poli et al, 2016b).

Methods

Results

Conclusion