EPA guidance on the early detection of clinical high risk states of psychoses

Schultze‐Lutter, Frauke; Michel, Chantal; Schmidt, Stefanie; Schimmelmann, Benno G.; Maric, Nadja P.; Salokangas, Raimo K. R.; Riecher-Rössler, Anita; Gaag, Mark van der; Nordentoft, Merete; Raballo, Andrea; Meneghelli, Anna; Marshall, Max; Morrison, Anthony P.; Ruhrmann, Stephan; Klosterkötter, Joachim

doi:10.1016/j.eurpsy.2015.01.010

Cited by 341 publications

(410 citation statements)

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“…While the preponderance of APS and the low frequency of BLIPS is consistent with findings from other clinical high risk populations 3,[35][36][37] , GRFD was more frequent than in most clinical UHR samples 3 .…”

Section: Uhr Symptoms and Criteriasupporting

confidence: 76%

“…Criteria have been developed to identify that high risk state: the ultra high risk (UHR) and the basic symptom criteria 1,2 . A recent metaanalysis reported an ability of UHR criteria to detect transition to psychosis within two years in 20% of individuals in clinical samples 3 . Yet, although persons with a clinical high risk state have a significantly increased risk of developing psychosis, many will not develop a psychotic disorder.…”

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confidence: 99%

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Ultra High Risk Status and Transition to Psychosis in 22q11.2 Deletion Syndrome

et al. 2017

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The 22q11.2 deletion syndrome (22q11DS) is characterized by high rates of psychotic symptoms and schizophrenia, making this condition a promising human model for studying risk factors for psychosis. We explored the predictive value of ultra high risk (UHR) criteria in a sample of patients with 22q11DS. We also examined the additional contribution of socio-demographic, clinical and cognitive variables to predict transition to psychosis within a mean interval of 32.5 6 17.6 months after initial assessment. Eighty-nine participants with 22q11DS (age range: 8-30 years; mean 16.1 6 4.7) were assessed using the Structured Interview for Psychosis-Risk Syndromes. Information on Axis I diagnoses, internalizing and externalizing symptoms, level of functioning and IQ was also collected. At baseline, 22 (24.7%) participants met UHR criteria. Compared to those without a UHR condition, they had a significantly lower functioning, more frequent anxiety disorders, and more severe psychopathology. Transition rate to psychosis was 27.3% in UHR and 4.5% in non-UHR participants. Cox regression analyses revealed that UHR status significantly predicted conversion to psychosis. Baseline level of functioning was the only other additional predictor. This is the first study investigating the predictive value of UHR criteria in 22q11DS. It indicates that the clinical path leading to psychosis is broadly comparable to that observed in other clinical high-risk samples. Nevertheless, the relatively high transition rate in non-UHR individuals suggests that other risk markers should be explored in this population. The role of low functioning as a predictor of transition to psychosis should also be investigated more in depth. . This syndrome is characterized in most cases by a microdeletion of 3 million base pairs on chromosome 22 band q11, and has an estimated prevalence of 1:2.000-4.000 live births 6 . From a clinical perspective, 22q11DS is associated with high rates of psychiatric disorders, especially schizophrenia 7 . While 23 to 45% of affected adolescents report transient psychotic experiences [8][9][10][11] , up to 40% of affected adults are diagnosed with a psychotic disorder 7 . Moreover, 22q11DS was found in 0.3 to 2.0% of patients with schizophrenia [12][13][14] , with rates of up to 5.7% in patients with childhood-onset schizophrenia 15 . Taken together, these findings indicate that 22q11DS is a highly relevant genetic risk factor for schizophrenia and the most promising human model for studying risk factors and states at risk for schizophrenia 5 .Several studies have investigated prodromal symptoms in patients with 22q11DS, reporting rates between 45 and 56% for UHR symptoms and between 10 and 21% for UHR criteria (including frequency and onset/worsening requirements) 8,10,11,[16][17][18] . Armando et al 8 compared the symptom profile of UHR patients with (N530) vs. without (N581) 22q11DS and found no significant group difference in positive symptoms, while negative symptoms were more severe in patients with 22q11DS. Yet, few stud...

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Section: Uhr Symptoms and Criteriasupporting

confidence: 76%

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confidence: 99%

Ultra High Risk Status and Transition to Psychosis in 22q11.2 Deletion Syndrome

et al. 2017

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“…Specifically, individuals referred by first episode and inpatient mental health services have a high pretest risk. 13 These findings advance knowledge indicating that CHR-P assessment should primarily be offered to selected samples of individuals "already distressed by mental problems and seeking help for them" (European Psychiatric Association recommendation n.4 14 ). Stratification of these subgroups 11 may inform outreach campaigns, subsequent testing 13 and optimize the psychosis prediction.…”

Section: Risk Enrichment and The Impact Of Recruitment Strategiesmentioning

confidence: 79%

The Clinical High-Risk State for Psychosis (CHR-P), Version II

Fusar‐Poli

2017

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The Clinical High-Risk state for psychosis (CHR-P) paradigm was introduced about 2 decades ago. Over this period of time accumulating knowledge has been gained. Conceptual advancements involve new knowledge into risk enrichment and the impact of recruitment strategies, specificity for prediction of psychotic and nonpsychotic mental disorders and heterogeneity of psychosis risk among the different CHR-P subgroups. The current special issue advances current knowledge on deconstructing the CHR-P paradigm across its 3 subgroups: genetic risk, attenuated psychotic symptoms, and short-lived and remitting psychotic episodes. A conceptual revision of the paradigm (Version II) is suggested and supported by 3 original studies published in this special issue.

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“…La última versión de la guía de práctica clínica para el manejo de psicosis y esquizofrenia del National Institute for Health and Clinical Excellence (NICE) británico (61) ha incluido por primera vez una sección donde se delinean recomendaciones basadas en los criterios UHR para detectar y luego prevenir el desarrollo de trastornos psicóticos en situaciones de riesgo elevado. En el año 2015 la Asociación Europea de Psiquiatría (EPA, por sus siglas en inglés), publicó guías para la detección e intervención temprana en ECAR hechas en base a metaanálisis de los estudios realizados a la fecha (62,63).…”

Section: Los Criterios De Ultra Alto Riesgo ("Ultra High Risk" Uhr)unclassified

Estados clínicos de alto riesgo para esquizofrenia y otras formas de psicosis: una breve revisión.

2017

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RESUMENLa esquizofrenia y cuadros psicóticos relacionados son trastornos complejos que generalmente emergen en el período de transición de la adolescencia hacia la adultez, por lo que sus consecuencias pueden ser deletéreas y producir un alto número de años de vida perdidos por discapacidad. Un importante factor pronóstico es el tiempo transcurrido entre el inicio de la enfermedad y el inicio del tratamiento farmacológico, por lo que la detección temprana de la enfermedad es factor imprescindible. En esta revisión se examinan aspectos históricos, neurobiológicos y concepciones acerca de los estadios clínicos de alto riesgo para el desarrollo de esquizofrenia. En el ámbito de predicción clínica se presentan el modelo de los "síntomas básicos" de Huber y Gross, y el modelo de "criterios de riesgo ultra alto para esquizofrenia" de Mc Gorry y colaboradores. Se revisan los debates y resultados de abordajes tanto farmacológicos como psicoterapéuticos y se subraya claramente la necesidad de utilizar protocolos de detección de las fases preclínicas de esquizofrenia y otras psicosis en nuestro país.PALABRAS CLAVE: Esquizofrenia, espectro esquizofrénico, trastornos psicóticos, diagnóstico precoz. SUMMARYSchizophrenia and related psychotic conditions are complex disorders that generally emerge during the transition from adolescence to adulthood, so that their consequences may be deleterious and produce a high number of years of life lost due to disability. An important prognostic factor is the time elapsed between the onset of the disease and the beginning of pharmacological treatment, reason for which the early detection of the disease is an essential factor. This review examines historical aspects, neurobiological findings and conceptions about the high risk clinical stages for the development of schizophrenia. . In the field of clinical prediction, Huber and Gross' "basic symptoms" model, and Mc Gorry et al's "ultrahigh risk criteria for schizophrenia" model are presented. Debates about and results of both pharmacological and psychotherapeutic approaches are examined and the need to utilize detection protocols of the preclinical phases of schizophrenia and other psychoses in our country is strongly emphasized.

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EPA guidance on the early detection of clinical high risk states of psychoses

Cited by 341 publications

References 131 publications

Ultra High Risk Status and Transition to Psychosis in 22q11.2 Deletion Syndrome

Ultra High Risk Status and Transition to Psychosis in 22q11.2 Deletion Syndrome

The Clinical High-Risk State for Psychosis (CHR-P), Version II

Estados clínicos de alto riesgo para esquizofrenia y otras formas de psicosis: una breve revisión.

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