Patients’, carers’ and clinicians’ attitudes towards alternative terms to describe the at-risk for psychosis state

Polari, Andrea; Street, Rebekah; Conus, Philippe; Finkelstein, Adam; Hartmann, Jessica A.; Kim, Sung‐Wan; McGorry, Patrick D.; Schley, Carsten; Simmons, Magenta; Stratford, John; Thompson, Andrew; Yung, Alison; Nelson, Barnaby; Lavoie, Suzie

doi:10.1016/j.schres.2021.08.031

Cited by 5 publications

(3 citation statements)

References 42 publications

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“…Polari et al's study, which surveyed ARMS patients and caregivers regarding their preference for the timing and extent of psychosis risk disclosure, broadly supports this notion. 51 All patients and caregivers in this study stated that they would prefer some information about their psychosis risk at some point in time, with 57% of patients stating that they would like the information 'as early as possible'. 52 An individual's right to be informed of medical information is enshrined in the 'European Convention for the protection of Human Rights and Dignity of the Human Being with regard to the Application of Biology and Medicine', Article 10(2).…”

Section: Respecting An Individual's Autonomous Preferencementioning

confidence: 79%

A principle‐based framework for disclosing a psychosis risk diagnosis

et al. 2022

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In recent decades, researchers have attempted to prospectively identify individuals at high risk of developing psychosis in the hope of delaying or preventing psychosis onset. These psychosis risk individuals are identified as being in an 'At-Risk Mental State' (ARMS) through a standardised psychometric interview. However, disclosure of ARMS status has attracted criticism due to concerns about the risk-benefit ratio of disclosure to patients. Only approximately one quarter of ARMS patients develop psychosis after three years, raising concerns about the unnecessary harm associated with such 'falsepositive' results. These harms are especially pertinent when identifying psychosis risk individuals due to potential stigma and discrimination in a young clinical population. A dearth of high-quality evidence supporting interventions for ARMS patients raises further doubts about the benefit accompanying an ARMS disclosure. Despite ongoing discussion in the bioethical literature, these concerns over the ethical justification of disclosure to ARMS patients are not directly addressed in clinical guidelines. In this paper, we aim to provide a unified disclosure strategy grounded in principle-based analysis for ARMS clinicians. After considering the ethical values at stake in ARMS disclosure, and their normative significance, we argue that full disclosure of the ARMS label is favoured in the vast majority of clinical situations due to the strong normative significance of enhancing patients' understanding. We then compare our framework with other approaches to ARMS disclosure and outline its limitations.

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Section: Respecting An Individual's Autonomous Preferencementioning

confidence: 79%

A principle‐based framework for disclosing a psychosis risk diagnosis

et al. 2022

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“…There are recent studies that relate the stigma associated with the diagnosis of UHR with a worse prognosis ( Colizzi et al, 2020 ) and stimulated negative stereotypes ( Woodberry et al, 2021 ). For this reason, alternative terms like pre-diagnosis stage’ (PDS), potential of developing a mental illness (PDMI), and disposition for developing a mental illness (DDMI) have been proposed that generate less discomfort among patients and families ( Polari et al, 2021a ). Generally, pharmacological therapy with antipsychotic medication is not recommended, and psychological interventions represent a more appropriate alternative to offer treatment to people at UHR ( NICE, 2014 ; Orygen The National Center of Excellence in Youth, 2016 ).…”

Section: Introductionmentioning

confidence: 99%

“…been proposed that generate less discomfort among patients and families (Polari et al, 2021a). Generally, pharmacological therapy with antipsychotic medication is not recommended, and psychological interventions represent a more appropriate alternative to offer treatment to people at UHR (NICE, 2014;Orygen The National Center of Excellence in Youth, 2016).…”

Section: Introductionmentioning

confidence: 99%

Application of the unified protocol for the transdiagnostic treatment of comorbid emotional disorders in patients with ultra-high risk of developing psychosis: A randomized trial study protocol

et al. 2022

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BackgroundCognitive Behavioral Therapy is delivered in most of the early intervention services for psychosis in different countries around the world. This approach has been demonstrated to be effective in decreasing or at least delaying the onset of psychosis. However, none of them directly affect the comorbidity of these types of patients that is often the main cause of distress and dysfunctionality. The Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders (UP) is a psychological intervention that combines cognitive-behavioral and third-generation techniques that address emotional dysregulation as an underlying mechanism that these disorders have in common. The application of this intervention could improve the comorbid emotional symptoms of these patients.Materials and methodsThe study is a randomized controlled trial in which one group receives immediate UP plus standard intervention and the other is placed on a waiting list to receive UP 7 months later, in addition to standard care in one of our early psychosis programs. The sample will be 42 patients with UHR for psychosis with comorbid emotional symptoms. The assessment is performed at baseline, at the end of treatment, and at 3-months’ follow-up, and includes: general psychopathology, anxiety and depression, positive and negative emotions, emotional dysregulation, personality, functionality, quality of life, cognitive distortions, insight, and satisfaction with the UP intervention.DiscussionThis will be the first study of the efficacy, acceptability, and viability of the UP in a sample of young adults with UHR. The results of this study may have clinical implications, contributing to improving the model of care for young people who consult for underlying psychotic, anxiety, and/or depressive symptoms that can lead to high distress and dysfunctionality.Clinical trial registration[https://clinicaltrials.gov/], identifier [NCT04929938].

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