Identification and treatment of the prodromal phase of psychotic disorders: perspectives from the PACE Clinic

Abstract

Aim: To describe the development of the field of prodromal intervention in psychotic disorders and to summarize the findings from the PACE Clinic, the inaugural service devoted to this area. Method:A review of the PACE Clinic studies, with reference to the work of other groups. Results:The aims of intervention before the onset of psychosis are to alleviate current distress and impairment and to either prevent, delay or ameliorate the onset of more severe psychotic disorder. To do this, it is necessary to be able to first accurately identify those in the earliest stages of a potentially serious psychotic disorder, and second to effectively slow or prevent progression to more advanced illness. Criteria have been developed which have predicted onset of psychotic disorder in over 30% of so-called 'ultra high risk' individuals. Treatment trials have been promising, and to date have examined the effects of antipsychotic medication, cognitive therapy and a combination of the two. Recently, omega-3 fatty acids have also been shown to be effective. However, there are also pitfalls of working in the prodromal area, including ethical concerns and more recently the possibility that there is a decline in the rate of transition from ultra-high-risk state to first-episode psychosis. Conclusions:The field of prodromal intervention in psychotic disorders is an exciting one as it offers the possibility of prevention of full-blown disorder and its related negative sequelae. However, there are many issues that need to be dealt with in order to achieve this goal, and ongoing evaluation of methods to identify and treat such individuals is needed.

14:15 Persistence of the Extended Psychosis Phenotype in Young People: Link Between Vulnerability and Clinical Need

“…The finding is consistent with suggestions that levels of depression mirror, almost exactly, levels of subclinical psychotic experiences in the general population (Yung et al, 2007;Wigman et al, 2011d). Van Os and Kapur (2009) suggest that psychosis consists of multiple domains (positive, negative, cognitive and affective symptoms).…”

“…These dimensions are comparable with those reported by Verdoux and colleagues (1998) reported by Stefanis and colleagues (2004), whereas Hallucinations and Delusions were grouped into a single dimension and Grandiosity and Paranormal beliefs into another in the study by Yung andcolleagues (2006, 2009). These studies together suggest (i) a similar underlying structure of mild positive psychotic experiences across different age groups and…”

“…Further down the psychosis continuum, subclinical psychotic symptoms and depression are associated in adolescent (Armando et al, 2010;Mackie et al, 2010;Yung et al, 2006;Wigman et al, 2011d) and adult (Krabbendam et al, 2005a) general population samples. From a longitudinal perspective, data from general population samples show that the developmental patterns of subclinical experiences mirror depressive symptoms in a dose response fashion over time (Yung, 2007;Wigman et al, 2011d). Additionally, the presence of depressive symptoms in combination with hallucinatory experiences increases the risk for a later diagnosis of clinical psychosis (Krabbendam et al, 2005b).…”

“…One of the factors that may play a role in the process of shifting along the psychosis continuum may be depression (Yung, 2007;van Rossum et al, 2011). Depression and positive psychosis are considered separate but interrelated dimensions of psychotic disorder (van Os & Kapur, 2009) and are closely related on all levels of the continuum.…”

“…In order to investigate effects of sex and age, all 20 frequency items were dichotomized into 0=never and 1=sometimes, often or nearly always. This approach was used in order to be consistent with Yung andcolleagues (2006, 2009), who previously developed this analytical framework. The sum of these 20 dichotomized item scores was used as continuous outcome score, indicating the total number of CAPE item endorsements and hereafter referred to as "CAPE item score".…”