Applying clinical staging to young people who present for mental health care

Hickie, Ian B.; Scott, Elizabeth; Hermens, Daniel F.; Naismith, Sharon L.; Guastella, Adam J.; Kaur, Manreena; Sidis, Anna; Whitwell, Bradley; Glozier, Nicholas; Davenport, Tracey A; Pantelis, Christos; Wood, Stephen; McGorry, Patrick

doi:10.1111/j.1751-7893.2012.00366.x

Cited by 192 publications

(321 citation statements)

References 26 publications

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“…To the best of our knowledge, the current assessment represents one of the only evidence based studies to directly test a theoretical stage model of the psychosis prodrome based primarily on symptom severity. 26 Specifically, in the present study we aim to examine: (1) The relationship between initial stage (CHR−, CHR+Mod, CHR+Sev, and SLP) and conversion rates over the course of the study with an average follow-up of 3 years; (2) The course of the initial stage diagnosis from baseline to study outcome in terms of remission, improvement, stability, worsening; and (3) The relationship between initial stage diagnosis and medication. Determining the risk of conversion to psychosis as well as stage persistence are important and necessary steps in providing a more complete understanding of the broader outcomes associated with risk for illness.…”

Section: Introductionmentioning

confidence: 99%

A Severity-Based Clinical Staging Model for the Psychosis Prodrome: Longitudinal Findings From the New York Recognition and Prevention Program

Carrión

Correll

Auther

et al. 2017

SCHBUL

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Clinical staging improved the possibility of intervening during the psychosis prodrome to limit progression of illness. The current study aimed to validate a novel 4-stage severitybased model with a focus on clinical change over time and risk for conversion to psychosis. One hundred seventy-one individuals at clinical high risk (CHR) for psychosis were followed prospectively (3 ± 1.6 y) as part of the Recognition and Prevention (RAP) program and divided into 4 diagnostic stages according to absence/presence and severity of attenuated positive symptoms. Twenty-two percent of the combined sample recovered (no prodromal symptoms) by study outcome. The negative symptoms only subgroup had the highest symptom stability (70%), but the lowest conversion rate at 5.9%. The subgroup with more severe baseline attenuated positive symptom levels had a higher conversion rate (28%) and a more rapid onset when compared to the moderate attenuated positive symptom subgroup (11%). Finally, the Schizophrenia-Like Psychosis (SLP) subgroup showed low stability (3%), with 49% developing a specific psychotic disorder. The proposed stage model provides a more finely grained classification system than the standard diagnostic approach for prodromal individuals. All 4 stages are in need of early intervention because of low recovery rates. The negative symptom only stage is possibly a separate clinical syndrome, with an increased risk of functional disability. Both subgroups with attenuated positive symptoms are appropriate for studying the mechanisms of psychosis risk, however, individuals with more severe baseline positive symptoms appear better suited to clinical trials. Finally, the SLP category represents an intermediate outcome group appropriate for preventative intervention research but questionable for inclusion in prodromal studies of mechanisms.

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Section: Introductionmentioning

confidence: 99%

A Severity-Based Clinical Staging Model for the Psychosis Prodrome: Longitudinal Findings From the New York Recognition and Prevention Program

Carrión

Correll

Auther

et al. 2017

SCHBUL

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“…During this period of life, the initial symptomatology across various diagnoses is often subsyndromal and there is a great need for early biomarkers and adapted interventions. 8,9 Furthermore, sleep disturbances observed in young adults often start during childhood or adolescence 10 and are associated with the onset and persistence of psychological distress. 11,12 Various studies have described sleep-wake profiles in cohorts of individuals with anxiety, mood or psychotic disorders compared with healthy controls.…”

Section: Introductionmentioning

confidence: 99%

Ambulatory sleep-wake patterns and variability in young people with emerging mental disorders

Robillard

Hermens

Naismith

et al. 2015

jpn

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“…Our previous research has shown that 15% of people in Stage 1b transition to Stage 2 within one year [5]; Stage 1a receive different and less intensive treatment compared with those in Stage 1b [21]; and young people in Stage 1b tend to remain impaired and distressed over time [21]. The presence of past mental health and suicidal thoughts and behaviours indicates that this group of young people require a more personalised treatment that not only covers their current needs but also responds appropriately to the higher stage they have reached over the course of their illness.…”

Section: Discussionmentioning

confidence: 99%

“…By the time most young people present to health services, they already have significant functional impairment, are psychologically distressed or have some degree of established comorbidity [4]. For these young people, the current psychiatric classification systems remain limited [5]; and, as interventions are often guided by diagnosis, young people experiencing sub-threshold symptomatology do not always receive appropriate care [6].…”

Section: Introductionmentioning

confidence: 99%

“…This framework supports the promotion of self-help and encourages an easier navigation for stepping-up through the mental health system [18]. Stepped (or clinically-staged) care aims to provide evidence-based, less intensive, low risk, and low-cost interventions to the less severe cases, while prioritising more intensive or prolonged interventions for more complex cases [5,[19][20][21][22][23].…”

Section: Introductionmentioning

confidence: 99%

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Using New and Innovative Technologies to Assess Clinical Stage in Early Intervention Youth Mental Health Services: Evaluation Study (Preprint)

Ospina-Pinillos¹,

Davenport²,

Iorfino³

et al. 2018

Preprint

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Background: Globally, there is increasing recognition that new strategies are required to reduce the disability due to common mental health problems. As 75% of mental health and substance misuse disorders emerge during the teenage or early adulthood years, these strategies need to be readily accessible to young people. When considering how to provide such services at scale, e-health technologies show promise in augmenting traditional clinicbased services. Objective: The aim of this study was to assess the effectiveness and accuracy of an online assessment of clinical staging for use in a prototypic Internet-based early intervention youth mental health service system, known as the Mental Health eClinic. Methods: An online version of clinical staging for early intervention youth mental health services, was compared directly with clinician assessments within two Sydney-based primary care service hubs (headspace Camperdown and Campbelltown). Two hundred and four (N=204) young people were recruited in the study. Eligible participants completed both faceto-face and online assessments which were randomly allocated and counterbalanced at a one-to-three ratio. These assessments were: (1) a traditional 45 to 60-minute headspace face-to-face assessment performed by a Youth Access Clinician; and (2) a self-report online survey followed by an online 'video-visit' assessment with a clinician taking approximately 15 minutes. All assessments were completed within a two-week timeframe from initial presentation. Results: Of the 72 participants who completed the study, 72% were female and the mean age was 20.4 years. Sixty eight percent (49/72) of the participants were recruited from headspace Camperdown and the remaining 32% (23/72) from headspace Campbelltown. Inter-rater agreement of participants' clinical stages, as determined after the face-to-face assessment and after the online assessment, demonstrated fair agreement (κ=0.39, P<0.001), with concordance in 68% of cases (49/72). In 26% of cases, the face-to-face assessment appeared to downrate the lifetime history of mental health problems. By contrast, the online evaluation placed greater weight on past history of mental health disorders (P=0.001), as well as any previous suicide planning (P=0.002) and current substance misuse (P=0.03). Conclusions:The online application of clinical staging presents a technologically-advanced and clinically-efficient method for determining key clinical service parameters. It has the potential to be adapted to varied settings in which young people are connecting with traditional clinical services and assist to provide optimal care.

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Applying clinical staging to young people who present for mental health care

Abstract: Among young people presenting for mental health care, most are clinically staged as having 'attenuated syndromes'. Despite access to specialized treatment, a significant number progress to more severe or persistent disorders.

Cited by 192 publications

References 26 publications

A Severity-Based Clinical Staging Model for the Psychosis Prodrome: Longitudinal Findings From the New York Recognition and Prevention Program

A Severity-Based Clinical Staging Model for the Psychosis Prodrome: Longitudinal Findings From the New York Recognition and Prevention Program

Ambulatory sleep-wake patterns and variability in young people with emerging mental disorders

Using New and Innovative Technologies to Assess Clinical Stage in Early Intervention Youth Mental Health Services: Evaluation Study (Preprint)

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