Identifying children and adolescents at ultra high risk of psychosis in Italian neuropsychiatry services: a feasibility study

Abstract

The past 20 years have seen the evolution of the construct of a clinical high-risk (hereafter, HR) state for psychosis. This construct is designed to capture the pre-psychotic phase. Some aspects of this approach, such as its feasibility in children and adolescents, are still under investigation. In the present study, we address the feasibility of implementing prodrome clinics for HR individuals within the framework of Italy's national child and adolescent neuropsychiatry services and the clinical relevance of a HR diagnosis in this population. Using the Comprehensive Assessment of At-Risk Mental States (CAARMS) to identify help-seeking patients meeting at least one HR criterion at baseline (HR+), we recruited 50 subjects for a feasibility study. The results obtained show that the Italian version of the CAARMS is easily administrable, causing patients no substantial discomfort. The prevalence of HR+ in our cohort was 44 %, which increased by an additional 18 % when negative symptoms were considered as an experimental inclusion criterion (HRNeg). The HR+ subjects were significantly more impaired in their social and occupational functioning than their HR- peers (subjects not at HR). The cumulative 1-year transition risk of psychosis of the HR+ group was 26.7 %. When the HRNeg group was added, the 1-year transition risk was 17.3 %. We suggest that administration of the CAARMS to children and adolescents with putative prodromal psychosis is feasible and that this assessment can easily be integrated into existing Italian neuropsychiatry services although clinicians should interpret results with caution as results in this age group still have to be replicated.

Characterization of children and adolescents with psychosis risk syndrome: The Children and Adolescents Psychosis Risk Syndrome (CAPRIS) study

“…Only 3.3% of our sample met ANS criteria exclusively, although 76.9% of the sample reported ANS combined with other criteria, in line with other published results (Spada et al, ). The idea of including patients with ANS without APS symptoms was inspired by the Recognition and Prevention Program in New York (Cornblatt, ; Lencz et al, ).…”

“…In our study, most PRSS reported APS at baseline, a larger proportion also presented ANS, while few showed GR plus deterioration, in line with results from other child and adolescent PRS studies (Cascio et al, 2016;Meyer et al, 2005;Spada et al, 2016;Ziermans et al, 2011).…”

“…The presence of attenuated positive symptoms (APS), brief limited intermittent psychotic symptoms (BLIPS) (no longer than one week) or a family history (FH) of psychosis/schizotypal personality disorder, plus impairment of functionality, were the first clinical criteria defined (McGorry, 1995;Yung et al, 2008;Yung & McGorry, 1996). Other clinical criteria were proposed by other groups, such as the presence of basic symptoms (Klosterkötter, Hellmich, Steinmeyer, & Schultze-Lutter, 2001), and the presence of negative attenuated symptoms (Lencz, Smith, Auther, Correll, & Cornblatt, 2004;Spada, Pistone, & Mcguire, 2016), with the aim of describing the first stage of the psychosis continuum, prior to the development of the three criteria mentioned (Schultze-Lutter, Ruhrmann, Berning, Maier, & Klosterkötter, 2010). The authors emphasize that combining attenuated negative symptoms (ANS) or Basic symptoms with the other criteria could improve predictive value (Cornblatt, Lencz, & Obuchowski, 2002; Schultze-Lutter, Klosterkötter, & Ruhrmann, 2014).…”

Early intervention for everyone? A review of cross‐cultural issues and their treatment in ultra‐high‐risk (UHR) cohorts

“…Australia (Conrad et al, 2017;Yung et al, 2006Yung et al, , 2008; 3 others emphasized an Asian perspective (Katsura et al, 2014;M. M. L. Lam et al, 2006;Lee et al, 2013) and another a Canadian point of view (Pruessner et al, 2015); 2 focused particularly on paediatric and youth (<18 years) populations (Spada et al, 2016;Welsh & Tiffin, 2014). Two studies analysed recruitment strategies in the framework of early detection (Francesconi et al, 2016;Rietdijk et al, 2012).…”

“…Broome et al, 2005;Demjaha et al, 2012;Fusar-Poli et al, 2013Hui et al, 2013;Ising, Kraan, et al, 2016;Ising, Ruhrmann, et al, 2016;Klauser et al, 2015;T. C. Kraan et al, 2017;Landa et al, 2016;Lee et al, 2013;Lim et al, 2015;Morcillo et al, 2015;Morrison et al, 2011;Rietdijk et al, 2010Rietdijk et al, , 2013Rutigliano et al, 2016;Spada et al, 2016;Valmaggia et al, 2014;Velthorst et al, 2012;Winton-Brown et al, 2015) (see Table 1). Only Table 1).…”