‘A Rose Is a Rose Is a Rose’, but At-Risk Criteria Differ

Schultze‐Lutter, Frauke; Schimmelmann, Benno G.; Ruhrmann, Stephan; Michel, Chantal

doi:10.1159/000339208

Cited by 57 publications

(53 citation statements)

References 89 publications

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“…Fifty-four patients (43.9%) were either diagnosed with a psychotic disorder or fulfilled criteria for an at-risk state for psychosis according to basic symptoms or ultra-high-risk criteria [20,34] (fig. 1).…”

Section: Methodsmentioning

confidence: 99%

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Self-Reported Psychotic-Like Experiences Are a Poor Estimate of Clinician-Rated Attenuated and Frank Delusions and Hallucinations

et al. 2013

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Background: One reason for the decision to delay the introduction of an Attenuated Psychosis Syndrome in the main text of the fifth edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders was the concern that attenuated psychotic symptoms (APS) might in fact be common features in adolescents and young adults from the general population of no psychopathological significance in themselves. This concern was based on reports of high prevalence rates of psychotic-like experiences (PLEs) in the general population and the assumption that PLEs are a good estimate of APS. Although the criterion validity of self-reported PLEs had already been studied with respect to clinician-rated psychotic symptoms and found insufficient, it had been argued that PLEs might in fact be more comparable with mild, subclinical expressions of psychotic symptoms and, therefore, with APS. The present paper is the first to specifically study this assumption. Sampling and Methods: The sample consisted of 123 persons seeking help at a service for the early detection of psychosis, of whom 54 had an at-risk mental state or psychosis, 55 had a nonpsychotic mental disorder and 14 had no full-blown mental disorder. PLEs were assessed with the Peters Delusion Inventory and the revised Launay-Slade Hallucination Scale, and psychotic symptoms and APS were assessed with the Structured Interview for Prodromal Syndromes. Results: At a level of agreement between the presence of any PLE (in 98.4% of patients) and any APS (in 40.7%) just exceeding chance (κ = 0.022), the criterion validity of PLEs for APS was insufficient. Even if additional qualifiers (high agreement or distress, preoccupation and conviction) were considered, PLEs (in 52.8%) still tended to significantly overestimate APS, and agreement was only fair (κ = 0.340). Furthermore, the group effect on PLE prevalence was, at most, moderate (Cramer's V = 0.382). Conclusions: The prevalence of APS cannot be deduced from studies of PLEs. Thus, the high population prevalence rate of PLEs does not allow the conclusion that APS are common features of no pathological significance and would lack clinical validity as an Attenuated Psychosis Syndrome in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition. Rather, the population prevalence rate of APS has to be assumed to be largely unknown at present but is likely lower than indicated by epidemiological studies of PLEs. Therefore, dedicated studies are warranted, in which APS are assessed in a way that equates to their clinical evaluation.

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Section: Methodsmentioning

confidence: 99%

“…In this original definition, psychotic-like phenomena are highly similar to APS [19] in the definition of the two main instruments for their assessment in a clinical interview [20], namely the Structured Interview for Prodromal Syndromes (SIPS) [21] and the Comprehensive Assessment of At-Risk Mental States [22]. …”

Section: Introductionmentioning

confidence: 99%

Self-Reported Psychotic-Like Experiences Are a Poor Estimate of Clinician-Rated Attenuated and Frank Delusions and Hallucinations

et al. 2013

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“…18 However, depending on the centre, the assessment scale, and (or) the time of their assessment, the exact definition of UHR criteria and conversion rates vary considerably between studies. 19,20 Moreover, the basic symptom criteria, COPER and COGDIS, are partially overlapping, but delineate risk of potentially different imminence and specificity-sensitivity ratio. [21][22][23][24] Nevertheless, both sets of at-risk criteria were developed solely 21 or predominately in adult samples (age 16 and older).…”

Section: 12mentioning

confidence: 99%

“…Further, 7.7% met UHR criteria according to the CAARMS, which has an extended onset criterion. 20 However, when including the 30% decrease in social functioning criterion-recently The Significance of At-Risk Symptoms for Psychosis in Children and Adolescents added as a criterion to the APS and BLIPS definitions according to the CAARMS 20 -only 0.9% (n = 2) of the children met UHR criteria. Notably, 89% of children with any APS reported distress caused by them.…”

Section: The Significance Of At-risk Criteria In the Child And Adolesmentioning

confidence: 99%

The Significance of At-Risk Symptoms for Psychosis in Children and Adolescents

2013

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The early detection and treatment of people at risk for psychosis is currently regarded as a promising strategy in fighting the devastating consequences of psychotic disorders. Currently, the 2 most broadly used sets of at-risk criteria, that is, ultra-high risk (UHR) and basic symptom criteria, were developed mainly in adult samples. We review the data regarding the presence and relevance of at-risk symptoms for psychosis in children and adolescents. The few existing studies suggest that attenuated psychotic symptoms (APS) and brief limited intermittent psychotic symptoms (BLIPS) do have some clinical relevance in young adolescents from the general population. Nevertheless, their differentiation from atypical psychotic symptoms or an emerging schizotypal personality disorder, as well as their stability and predictive accuracy for psychosis, are still unclear. Further, standard interviews for UHR criteria do not define a minimum age for the assessment of APS and BLIPS or guidelines as to when and how to include information from parents. APS and basic symptoms may be predictive of conversion to psychosis in help-seeking young adolescents. Nevertheless, the rate and timing, and thus the required observation time, need further study. Moreover, no study has yet addressed the issue of how to treat children and adolescents presenting with at-risk symptoms and criteria. Further research is urgently needed to examine if current at-risk criteria and approaches have to be tailored to the special needs of children and adolescents. A preliminary rationale for how to deal with at-risk symptoms for psychosis in clinical practice is provided. W W W La signification des symptômes à risque de psychose chez les enfants et les adolescentsLa détection et le traitement précoces des personnes à risque de psychose sont actuellement réputés constituer une stratégie prometteuse pour combattre les conséquences désastreuses des troubles psychotiques. À l'heure actuelle, les 2 ensembles les plus utilisés de critères à risque, c'est-à-dire, le risque ultra-élevé (RUE) et les critères des symptômes de base, ont été développés principalement pour des échantillons adultes. Nous examinons les données au regard de la présence et de la pertinence des symptômes à risque de psychose chez les enfants et les adolescents. Les quelques études existantes suggèrent que les symptômes psychotiques atténués (SPA) et les symptômes psychotiques brefs, limités et intermittents (BLIPS) ont une certaine pertinence clinique chez les jeunes adolescents de la population générale. Néanmoins, leur différenciation des symptômes psychotiques atypiques ou d'un trouble de la personnalité schizotypique naissant, ainsi que leur stabilité et leur exactitude à prédire la psychose sont encore indéfinies. De plus, les entrevues standards pour les critères RUE ne fixent pas d'âge minimum pour l'évaluation des SPA et des BLIPS, ni n'offrent de guides sur le moment et la manière d'inclure l'information des parents. Les SPA et les symptômes de base peuvent prédire une conversion à...

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“…1,2 Ultrahigh risk (UHR) criteria have been defined to prospectively identify people in this prodromal phase. [3][4][5][6] In a recent meta-analysis, 7 the average 1-year transition rate to first episode psychosis in UHR subjects was 21.7%, increasing to 31.5% after 3 years of follow-up.…”

Section: Introductionmentioning

confidence: 99%

174.2 Psychosis Prediction: Stratification of Risk Estimation With Information-Processing and Premorbid Functioning Variables

Nieman

Ruhrmann

Tricht

et al. 2017

Schizophrenia Bulletin

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Background:The period preceding the first psychotic episode is regarded as a promising period for intervention. We aimed to develop an optimized prediction model of a first psychosis, considering different sources of information. The outcome of this model may be used for individualized risk estimation. Methods: Sixty-one subjects clinically at high risk (CHR), participating in the Dutch Prediction of Psychosis Study, were assessed at baseline with instruments yielding data on neuropsychology, symptomatology, environmental factors, premorbid adjustment, and neurophysiology. The follow-up period was 36 months. Results: At 36 months, 18 participants (29.5%) had made a transition to psychosis. Premorbid adjustment (P = .001, hazard ratio [HR] = 2.13, 95% CI = 1.39/3.28) and parietal P300 amplitude (P = .004, HR = 1.27, 95% CI = 1.08/1.45) remained as predictors in the Cox proportional hazard model. The resulting prognostic score (PS) showed a sensitivity of 88.9% and a specificity of 82.5%. The area under the curve of the PS was 0.91 (95% CI = 0.83-0.98, cross-validation: 0.86), indicating an outstanding ability of the model to discriminate between transition and nontransition. The PS was further stratified into 3 risk classes establishing a prognostic index. In the class with the worst social-personal adjustment and lowest P300 amplitudes, 74% of the subjects made a transition to psychosis. Furthermore, transition emerged on average more than 17 months earlier than in the lowest risk class. Conclusions: Our results suggest that predicting a first psychotic episode in CHR subjects could be improved with a model including premorbid adjustment and information-processing variables in a multistep algorithm combining risk detection and stratification.

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‘A Rose Is a Rose Is a Rose’, but At-Risk Criteria Differ

Cited by 57 publications

References 89 publications

Self-Reported Psychotic-Like Experiences Are a Poor Estimate of Clinician-Rated Attenuated and Frank Delusions and Hallucinations

Self-Reported Psychotic-Like Experiences Are a Poor Estimate of Clinician-Rated Attenuated and Frank Delusions and Hallucinations

The Significance of At-Risk Symptoms for Psychosis in Children and Adolescents

174.2 Psychosis Prediction: Stratification of Risk Estimation With Information-Processing and Premorbid Functioning Variables

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