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The ‘At-Risk Mental State’ for Psychosis in Adolescents: Clinical Presentation, Transition and Remission

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Abstract

Despite increased efforts over the last decade to prospectively identify individuals at ultra-high risk of developing a psychotic illness, limited attention has been specifically directed towards adolescent populations (<18 years). In order to evaluate how those under 18 fulfilling the operationalised criteria for an At-Risk Mental State (ARMS) present and fare over time, we conducted an observational study. Participants (N = 30) generally reported a high degree of functional disability and frequent and distressing perceptual disturbance, mainly in the form of auditory hallucinations. Seventy percent (21/30) were found to fulfil the criteria for a co-morbid ICD-10 listed mental health disorder, with mood (affective; 13/30) disorders being most prevalent. Overall transition rates to psychosis were low at 24 months follow-up (2/28; 7.1 %) whilst many participants demonstrated a significant reduction in psychotic-like symptoms. The generalisation of these findings may be limited due to the small sample size and require replication in a larger sample.

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Abbreviations

ARMS:

At-Risk Mental State for psychosis

References

  1. Yung AR, McGorry PD (1996) The initial prodrome in psychosis: descriptive and qualitative aspects. Aust N Z J Psychiatry 30(5):587–599

    Article  PubMed  Google Scholar 

  2. Yung AR, McGorry PD, McFarlane CA, Jackson HJ, Patton GC, Rakkar A (1996) Monitoring and care of young people at incipient risk of psychosis. Schizophr Bull 22(2):283–303

    Article  PubMed  Google Scholar 

  3. Carpenter WT (2009) Anticipating DSM-V: should psychosis risk become a diagnostic class? Schizophr Bull 35(5):841–843

    Article  PubMed  Google Scholar 

  4. Woods SW, Addington J, Cadenhead KS, Cannon TD, Cornblatt BA, Heinssen R et al (2009) Validity of the prodromal risk syndrome for first psychosis: findings from the North American prodrome longitudinal study. Schizophr Bull 35(5):894–908

    Article  PubMed  Google Scholar 

  5. Corcoran CM, First MB, Cornblatt B (2010) The psychosis risk syndrome and its proposed inclusion in the DSM-V: A risk-benefit analysis. Schizophr Res 120(1–3):16–22

    Article  PubMed Central  PubMed  Google Scholar 

  6. Heinssen RK, Perkins DO, Appelbaum PS, Fenton WS (2000) Informed consent in early psychosis research: National Institute of Mental Health Workshop, November 15. Schizophr Bull 27(4):571–583

    Article  Google Scholar 

  7. Maier M, Cornblatt BA, Merikangas KR (2003) Transition to schizophrenia and related disorders: toward a taxonomy of risk. Schizophr Bull 29(4):693–701

    Article  PubMed  Google Scholar 

  8. Maxmen A (2012) Psychosis risk syndrome excluded from DSM-5. Nature news. http://www.nature.com/news/psychosis-risk-syndrome-excluded-from-dsm-5-1.10610. Accessed May 9, 2012

  9. Hollis C (2000) Adult outcomes of child- and adolescent-onset schizophrenia: diagnostic stability and predictive validity. Am J Psychiatry 157(10):1652–1659

    Article  PubMed  Google Scholar 

  10. Schmidt M, Blanz B, Dippe A (1995) Course of patients diagnosed as having schizophrenia during first episode occurring under age 18 years. Eur Arch Psychiatry Clin Neurosci 245:93–100

    Article  PubMed  Google Scholar 

  11. Boeing L, Murray V, Pelosi A, McCabe R, Blackwood D, Wrate R (2007) Adolescent-onset psychosis: prevalence, needs and service provision. Br J Psychiatry 190(1):18–26

    Article  PubMed  Google Scholar 

  12. Joa I, Johannessen JO, Langeveld J, Friis S, Melle I, Opjordsmoen S et al (2009) Baseline profiles of adolescent vs. adult-onset first-episode psychosis in an early detection program. Acta Psychiatr Scand 119(6):494–500

    Article  PubMed  Google Scholar 

  13. Borgmann-Winter K, Calkins M, Kniele K, Gur RE (2006) Assessment of adolescents at risk for psychosis. Curr Psychiatry Rep 8:313–321

    Article  PubMed  Google Scholar 

  14. Harrop C, Trower P (2001) Why does schizophrenia develop at late adolescence? Clin Psychol Rev 21(2):241–265

    Article  PubMed  Google Scholar 

  15. Escher S, Romme M, Buiks A, Van Os J (2002) Independent course of childhood auditory hallucinations: a sequential 3-year follow-up study. Br J Psychiatry 181(suppl. 43):S10–S18

    Article  Google Scholar 

  16. Simon AE, Cattapan-Ludewig K, Gruber K, Ouertani J, Zimmer A, Roth B et al (2009) Subclinical hallucinations in adolescent outpatients: an outcome study. Schizophr Res 108(1–3):265–271

    Article  PubMed  Google Scholar 

  17. Kelleher I, Keeley H, Corcoran P, Lynch F, Fitzpatrick C, Devlin N et al (2012) Clinicopathological significance of psychotic experiences in non-psychotic young people: evidence from four population-based studies. Br J Psychiatry 201(1):26–32

    Article  PubMed  Google Scholar 

  18. Laurens KR, Hodgins S, Maughan B, Murray RM, Rutter ML, Taylor EA (2007) Community screening for psychotic-like experiences and other putative antecedents of schizophrenia in children aged 9–12 years. Schizophr Res 90(1–3):130–146

    Article  PubMed  Google Scholar 

  19. Spauwen J, Krabbendam L, Lieb R, Wittchen HU, Van Os J (2003) Sex differences in psychosis: normal or pathological? Schizophr Res 62(1–2):45–49

    Article  PubMed  Google Scholar 

  20. Van Os J, Linscott RJ, Myin-Germeys I, Delespaul P, Krabbendam L (2009) A systematic review and meta-analysis of the psychosis continuum: evidence for a psychosis proneness–persistence–impairment model of psychotic disorder. Psychol Med 39(2):179–195

    Article  PubMed  Google Scholar 

  21. Bentall RP, Morrison AP (2002) More harm than good: the case against using antipsychotic drugs to prevent severe mental illness. J Ment Health 11(4):351–356

    Article  Google Scholar 

  22. MacDonald E, Sauer K, Howie L, Albiston D (2005) What happens to social relationships in early psychosis? A phenomenological study of young people’s experiences. J Ment Health 14(2):129–143

    Article  Google Scholar 

  23. Yang LH, Wonpat-Borja AJ, Opler MG, Corcoran CM (2010) Potential stigma associated with inclusion of the psychosis risk syndrome in the DSM-V: an empirical question. Schizophr Res 120(1–3):42–48

    Article  PubMed Central  PubMed  Google Scholar 

  24. Addington J, Cadenhead KS, Cannon TD, Cornblatt B, McGlashan TH, Perkins DO et al (2007) North American prodrome longitudinal study: a collaborative multisite approach to prodromal schizophrenia research. Schizophr Bull 33(3):665–672

    Article  PubMed  Google Scholar 

  25. Morrison AP, Stewart SL, French P, Bentall RP, Birchwood M, Byrne R et al (2011) Early detection and intervention evaluation for people at high-risk of psychosis-2 (EDIE-2): trial rationale, design and baseline characteristics. Early Interv Psychiatry 5:24–32

    Article  PubMed  Google Scholar 

  26. Broome MR, Woolley JB, Johns LC, Valmaggia LR, Tabraham P, Gafoor R et al (2005) Outreach and support in south London (OASIS): implementation of a clinical service for prodromal psychosis and the at risk mental state. Eur Psychiatry 20(5–6):372–378

    Article  PubMed  Google Scholar 

  27. Rosen JL, Miller TJ, D’Andrea JT, McGlashan TH, Woods SW (2006) Comorbid diagnoses in patients meeting criteria for the schizophrenia prodrome. Schizophr Res 85:124–131

    Article  PubMed  Google Scholar 

  28. Svirskis T, Korkeila J, Heinimaa M, Huttunen J, Ilonen T, Ristkari T et al (2007) Quality of life and functioning ability in subjects vulnerable to psychosis. Compr Psychiatry 48(2):155–160

    Article  PubMed  Google Scholar 

  29. Mason O, Startup M, Halpin S, Schall U, Conrad A, Carr V (2004) Risk factors for transition to first episode psychosis among individuals with `at-risk mental states’. Schizophr Res 71:227–237

    Article  PubMed  Google Scholar 

  30. Miller TJ, Zipursky RB, Perkins D, Addington J, Woods SW, Hawkins KA et al (2003) The PRIME North America randomized double-blind clinical trial of olanzapine versus placebo in patients at risk of being prodromally symptomatic for psychosis: II. Baseline characteristics of the “prodromal” sample. Schizophr Res 61(1):19–30

    Article  PubMed  Google Scholar 

  31. Yung AR, Phillips LJ, Yuen HP, Francey SM, McFarlane CA, Hallgren M et al (2003) Psychosis prediction: 12-month follow up of a high-risk (“prodromal”) group. Schizophr Res 60(1):21–32

    Article  PubMed  Google Scholar 

  32. Preti A, Meneghelli A, Pisano A, Cocchi A (2009) Risk of suicide and suicidal ideation in psychosis: results from an Italian multi-modal pilot program on early intervention in psychosis. Schizophr Res 113(2–3):145–150

    Article  PubMed  Google Scholar 

  33. Fusar-Poli P, Bonoldi I, Yung AR, Borgwardt S, Kempton MJ, Valmaggia L et al (2012) Predicting psychosis: meta-analysis of transition outcomes in individuals at high clinical risk. Arch Gen Psychiatry 69(3):220–229

    Article  PubMed  Google Scholar 

  34. Yung AR, Nelson B, Stanford C, Simmons MB, Cosgrave EM, Killackey E et al (2008) Validation of “prodromal” criteria to detect individuals at ultra high risk of psychosis: 2 year follow-up. Schizophr Res 105(1–3):10–17

    Article  PubMed  Google Scholar 

  35. Correll C, Lencz T, Smith C, Auther AM, Nakayama EY, Hovey L et al (2005) Prospective study of adolescents with subsyndromal psychosis: characteristics and outcome. J Child Adolesc Psychopharmacol 15(3):418–433

    Article  PubMed  Google Scholar 

  36. Meyer SE, Bearden CE, Lux S, Gordon JL, Johnson JK, O’Brien MP et al (2005) The psychosis prodrome in adolescent patients viewed through the lens of DSM-IV. J Child Adolesc Psychopharmacol 15(3):434–451

    Article  PubMed  Google Scholar 

  37. Mazzoni P, Kimhy D, Khan S, Posner K, Maayan L, Eilenberg M et al (2009) Childhood onset diagnoses in a case series of teens at clinical high risk for psychosis. J Child Adolesc Psychopharmacol 19(6):771–776

    Article  PubMed  Google Scholar 

  38. Ziermans TB, Schothorst PF, Sprong M, van Engeland H (2011) Transition and remission in adolescents at ultra-high risk for psychosis. Schizophr Res 126(1–3):58–64

    Article  PubMed  Google Scholar 

  39. Ziermans TB, Durston S, Sprong M, Nederveen H, van Haren NE, Schnack HG et al (2009) No evidence for structural brain changes in young adolescents at ultra high risk for psychosis. Schizophr Res 112(1):1–6

    Article  PubMed  Google Scholar 

  40. Amminger GP, Leicester S, Yung AR, Phillips LJ, Berger GE, Francey SM et al (2006) Early-onset of symptoms predicts conversion to non-affective psychosis in ultra-high risk individuals. Schizophr Res 84(1):67–76

    Article  PubMed  Google Scholar 

  41. NICE (2013) Psychosis and schizophrenia in children and young people: recognition and management. CG155. National Institute for Health and Clinical Excellence, London

  42. Yung AR, Yuen HP, McGorry PD, Phillips LJ, Kelly D, Dell’Olio M et al (2005) Mapping the onset of psychosis: the comprehensive assessment of at-risk mental states. Aust N Z J Psychiatry 39:964–971

    Article  PubMed  Google Scholar 

  43. Shaffer D, Gould M, Brasic J, Ambrosini P, Fisher P, Bird H et al (1983) A children’s global assessment scale (CGAS). Arch Gen Psychiatry 40:1228–1231

    Article  PubMed  Google Scholar 

  44. Goodman R, Ford T, Richards H, Gatward R, Meltzer H (2000) The development and well-being assessment: description and initial validation of an integrated assessment of child and adolescent psychopathology. J Child Psychol Psychiatry 41(5):645–655

    Article  PubMed  Google Scholar 

  45. Leckman JF, Sholomskas D, Thompson WD, Belanger A, Weissman MM (1982) Best estimate of lifetime psychiatric diagnosis: a methodological study. Arch Gen Psychiatry 39(8):879–883

    Article  PubMed  Google Scholar 

  46. Young RC, Biggs JT, Ziegler VE, Meyer DA (1978) A rating scale for mania: reliability, validity and sensitivity. Br J Psychiatry 133(5):429–435

    Article  PubMed  Google Scholar 

  47. Hamilton M (1960) A rating scale for depression. J Neurol Neurosurg Psychiatry 23(1):56–62

    Article  PubMed  Google Scholar 

  48. Skuse DH, Mandy WPL, Scourfield J (2005) Measuring autistic traits: heritability, reliability and validity of the social and communication disorders checklist. Br J Psychiatry 187(6):568–572

    Article  PubMed  Google Scholar 

  49. Maher BA (1974) Delusional thinking and perceptual disorder. J Individ Psychol 30(1):98–113

    PubMed  Google Scholar 

  50. Freeman D, Garety PA, Kuipers E (2001) Persecutory delusions: developing the understanding of belief maintenance and emotional distress. Psychol Med 31(7):1293–1306

    Article  PubMed  Google Scholar 

  51. Putnam FW (1993) Dissociative disorders in children: behavioral profiles and problems. Child Abuse Negl 17:39–45

    Article  PubMed  Google Scholar 

  52. McGorry P (2007) The specialist youth mental health model: strengthening the weakest link in the public mental health system. Med J Aust 187(Suppl. 7):S53–S56

    PubMed  Google Scholar 

  53. Padgett FE, Miltsiou E, Tiffin PA (2010) The co-occurrence of nonaffective psychosis and the pervasive developmental disorders: a systematic review. J Intellect Dev Disabil 35(3):187–198

    Article  PubMed  Google Scholar 

  54. Heinimaa M, Salokangas RK, Ristkari T, Plathin M, Huttunen J, Ilonen T et al (2003) PROD-screen—a screen for prodromal symptoms of psychosis. Int J Methods Psychiatr Res 12(2):92–104

    Article  PubMed  Google Scholar 

  55. Yung AR, Phillips LJ, Nelson B, Francey SM, PanYuen H, Simmons MB et al (2011) Randomized controlled trial of interventions for young people at ultra high risk for psychosis: 6-month analysis. J Clin Psychiatry 72(4):430–440

    Article  PubMed  Google Scholar 

  56. Fusar-Poli P, Byrne M, Valmaggia L, Day F, Tabraham P, Johns L et al (2009) Social dysfunction predicts two years clinical outcomes in people at ultrahigh risk for psychosis. J Psychiatr Res 44(5):294–301

    Article  Google Scholar 

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Authors and Affiliations

  1. School for Health, The Wolfson Research Institute, Durham University, Queen’s Campus, Stockton-on-Tees, TS17 6BH, UK

    Patrick Welsh & Paul A. Tiffin

  2. Early Intervention in Psychosis Service, Tees, Esk and Wear Valleys NHS Foundation Trust, Bishop Auckland, UK

    Patrick Welsh

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  1. Patrick Welsh
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  2. Paul A. Tiffin
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Correspondence to Patrick Welsh.

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Welsh, P., Tiffin, P.A. The ‘At-Risk Mental State’ for Psychosis in Adolescents: Clinical Presentation, Transition and Remission. Child Psychiatry Hum Dev 45, 90–98 (2014). https://doi.org/10.1007/s10578-013-0380-z

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