Detection of people at risk of developing a first psychosis: comparison of two recruitment strategies

Rietdijk, Judith; Klaassen, Rianne; Ising, Helga K.; Dragt, Sara; Nieman, Dorien H.; Kamp, J. van de; Cuijpers, Pim; Linszen, Don; Gaag, Mark van der

doi:10.1111/j.1600-0447.2012.01839.x

Cited by 74 publications

(78 citation statements)

References 43 publications

(88 reference statements)

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“…In fact, preliminary data indicates that distress associated with attenuated psychotic symptoms or reason for referral being due to attenuated psychotic symptoms [5] does not correspond to higher risk for transition to psychotic disorder. The findings of Rietdijk et al [11] are consistent with this. They found that at-risk patients ascertained via a traditional case-recruitment strategy, relying on referral when psychotic symptoms were suspected, resulted in lower transition rates to psychosis than sequential screening of a help-seeking population entering secondary mental health services for non-psychotic problems.…”

Section: Distress Associated With Apssupporting

confidence: 82%

Attenuated Psychosis Syndrome: Don't Jump the Gun

Nelson¹

2014

Psychopathology

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Attenuated psychosis syndrome (APS) was introduced in DSM-5 as a condition for further study. A number of concerns have been raised regarding APS, including its validity as a clinical entity, issues relating to stigma, the potential that it is an unnecessary diagnosis of what might be a self-limiting phase of attenuated psychotic symptoms, and treatment implications of the diagnosis. The current paper presents a number of conceptual and practical issues that should be addressed in deciding whether APS should be accepted as an official diagnosis in subsequent editions of DSM. These include the problem of transferring the established validity of ‘at-risk' criteria to APS given some non-trivial differences between the criteria sets, the relationship between attenuated psychotic symptoms and other presenting non-psychotic disorders, the difficulties of operationalising the subthreshold or ‘attenuated' concept in standard clinical practice, and the likelihood of the diagnosis leading to overprescription of antipsychotic medication for this group of patients.

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Section: Distress Associated With Apssupporting

confidence: 82%

Attenuated Psychosis Syndrome: Don't Jump the Gun

Nelson¹

2014

Psychopathology

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“…Consequently, had they been used as a screener as suggested by several studies [36,37,38], simple-rated PLEs would have been highly sensitive but far too unspecific, as they would have detected nearly everyone with mental problems presenting at the early detection center, including those without any mental disorder. The specificity of PLEs might have been higher at higher thresholds, but most likely at the cost of sensitivity, as reported in a study evaluating the CAPE as a screening instrument for at-risk states according to the Comprehensive Assessment of At-Risk Mental States [36].…”

Section: Discussionmentioning

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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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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“…Only 6.9% of this subsample reported distress associated with their attenuated psychotic symptoms (Kelleher et al, 2012). Other studies that explored screening strategies for detection of people at risk of developing psychosis found higher rates of transition to psychotic disorder in young people meeting UHR criteria who were seeking help for general (non-psychotic) psychiatric problems than in a UHR group referred to specialized services for psychosis Rietdijk et al, 2012). The distress associated with the APS in the former group was presumably lower than in the latter group, because these symptoms were only detected via screening and were not necessarily a significant source of distress or reason for help-seeking/referral.…”

Section: Introductionmentioning

confidence: 96%

“…Based on the clinical observations noted above it was hypothesised that the main source of clinical distress experienced by UHR patients would be non-specific psychopathology rather than APS. We also hypothesised, based on previous findings Rietdijk et al, 2012), that the level of distress associated with those non-psychosis related symptoms would be more predictive of transition to psychosis than distress associated to APS alone.…”

Section: Introductionmentioning

confidence: 99%