Demographic and clinical characteristics of young people seeking help at youth mental health services: baseline findings of the <scp>T</scp>ransitions <scp>S</scp>tudy

Purcell, Rosemary; Jorm, Anthony F.; Hickie, Ian B.; Yung, Alison R.; Pantelis, Christos; Amminger, G. Paul; Killackey, Eóin; Phillips, Lisa; Wood, Stephen J.; Harrigan, Susy; Mackinnon, Andrew; Scott, Elizabeth; Hermens, Daniel F.; Guastella, Adam J.; Kenyon, Amanda; Mundy, Laura; Nichles, Alissa; Scaffidi, Antoinette; Spiliotacopoulos, Daniela; Taylor, Lucy; Tong, Janet; Wiltink, Suzanne; Zmicerevska, Natalia; McGorry, Patrick D.

doi:10.1111/eip.12133

Cited by 61 publications

(64 citation statements)

References 41 publications

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“…Finally, although we did report factor loadings for depressive symptom severity, we did not report on all conventional diagnostic criteria such as psychotic or manic symptoms collected in the Transition Study. Although these measures were found to be highly skewed in the sample, as can be expected, and therefore unlikely to impact our results (Purcell et al, 2015), future studies may benefit from an investigation of factor loadings of other diagnostic measures.…”

Section: Discussionmentioning

confidence: 54%

Can youth at high risk of illness progression be identified by measures of rumination and sleep‐wake disturbance

Grierson

Scott

Glozier

et al. 2018

Early Intervention Psych

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Aim: Clinical staging models offer a useful framework for understanding illness trajectories, where individuals are located on a continuum of illness progression from stage 0 (at-risk but asymptomatic) to stage 4 (end-stage disease). Importantly, clinical staging allows investigation of risk factors for illness progression with the potential to target trans-diagnostic mechanisms at an early stage, especially in help-seeking youth who often present with sub-threshold syndromes.While depressive symptoms, rumination and sleep-wake disturbances may worsen syndrome outcomes, the role of these related phenomena has yet to be examined as risk factors for transdiagnostic illness progression in at-risk youth.Methods: This study is a prospective follow-up of 248 individuals aged 12 to 25 years presenting to headspace services with sub-threshold syndromes (stage 1) classified under the clinical staging model to determine transition to threshold syndromes (stage 2). Factor analysis of depression, rumination and sleep-wake patterns was used to identify key dimensions and any associations between factors and transition to stage 2 at follow-up.Results: At 1 year, 9% of cases met criteria for stage 2 (n = 22). One of three identified factors, namely the factor reflecting the commonalities shared between rumination and sleep-wake disturbance, significantly differentiated cases that transitioned to stage 2 vs those that did not demonstrate transition. Items loading onto this factor, labelled Anergia, included depression severity and aspects of rumination and sleep-wake disturbance that were characterized as introceptive.Conclusions: Common dimensions between rumination and sleep-wake disturbance present a detectable trans-diagnostic marker of illness progression in youth, and may represent a target for early intervention.

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Section: Discussionmentioning

confidence: 54%

Can youth at high risk of illness progression be identified by measures of rumination and sleep‐wake disturbance

Grierson

Scott

Glozier

et al. 2018

Early Intervention Psych

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“…On the other hand, with broad spectrum youth mental health care primary care platforms, such as headspace, we now know that a much higher number of such young people can be engaged. In a recent study, we found that 38% of young people accessing these services reported attenuated psychotic symptoms likely to be in the UHR range.…”

Section: Solving the Prevention Paradox: Unlocking The Secret To Pre‐mentioning

confidence: 99%

Beyond the “at risk mental state” concept: transitioning to transdiagnostic psychiatry

et al. 2018

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The "at risk mental state" for psychosis approach has been a catalytic, highly productive research paradigm over the last 25 years. In this paper we review that paradigm and summarize its key lessons, which include the valence of this phenotype for future psychosis outcomes, but also for comorbid, persistent or incident non-psychotic disorders; and the evidence that onset of psychotic disorder can at least be delayed in ultra high risk (UHR) patients, and that some full-threshold psychotic disorder may emerge from risk states not captured by UHR criteria. The paradigm has also illuminated risk factors and mechanisms involved in psychosis onset. However, findings from this and related paradigms indicate the need to develop new identification and diagnostic strategies. These findings include the high prevalence and impact of mental disorders in young people, the limitations of current diagnostic systems and risk identification approaches, the diffuse and unstable symptom patterns in early stages, and their pluripotent, transdiagnostic trajectories. The approach we have recently adopted has been guided by the clinical staging model and adapts the original "at risk mental state" approach to encompass a broader range of inputs and output target syndromes. This approach is supported by a number of novel modelling and prediction strategies that acknowledge and reflect the dynamic nature of psychopathology, such as dynamical systems theory, network theory, and joint modelling. Importantly, a broader transdiagnostic approach and enhancing specific prediction (profiling or increasing precision) can be achieved concurrently. A holistic strategy can be developed that applies these new prediction approaches, as well as machine learning and iterative probabilistic multimodal models, to a blend of subjective psychological data, physical disturbances (e.g., EEG measures) and biomarkers (e.g., neuroinflammation, neural network abnormalities) acquired through fine-grained sequential or longitudinal assessments. This strategy could ultimately enhance our understanding and ability to predict the onset, early course and evolution of mental ill health, further opening pathways for preventive interventions.

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“…This is a key strength of the model as it is able to effectively manage a high volume of cases through its broad-based entry, which is not possible through narrow approaches such as UHR clinics and traditional child and adolescent mental health services 22. The number of headspace clients with subthreshold psychotic symptoms ranges from 23% (based on preliminary findings from a large trial of UHR cases)23 to 38% 24. It is likely that not all of these cases would meet the full UHR criteria, however, access to care is clearly enhanced for earlier stage cases.…”

Section: Transition and Its Limitationsmentioning

confidence: 99%

Ultra-high-risk paradigm: lessons learnt and new directions

McGorry

Mei

2018

Evid Based Mental Health

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Within the embryonic early psychosis field in the early 1990s, the conceptualisation and definition of an at-risk or ultra-high-risk (UHR) mental state for psychosis was a breakthrough which transformed the clinical and research landscape in psychiatry. Twenty-five years later, we have a new evidence base that has illuminated the neurobiology of the onset phase of psychotic disorder, delivered Cochrane level 1 evidence showing that the onset of full-threshold sustained psychotic disorder can be at least delayed, and is paving the way to a new generation of transdiagnostic research. Here, we document the contribution of the UHR approach to understanding the underlying mechanisms of psychosis onset as well as the long-term outcomes. Particularly, we highlight that psychosis onset can be delayed in those meeting UHR criteria and that these criteria have a higher valence for subsequent psychotic disorders and some valence for persistent non-psychotic syndromes. Critiques have helped to identify some of the limitations of this paradigm, which are acknowledged. These include evidence that psychotic disorders can emerge more acutely and from other, as yet undefined, precursor states. Rather than defending, or alternatively questioning the value of, the UHR approach, we propose a broader, transdiagnostic staging model that is consistent with the pluripotent and variably comorbid trajectories for mental disorders. This approach moves beyond psychosis to capture a wider range of subthreshold symptoms and full-threshold disorders, thus enhancing prediction for the emergence and progression of a range of mental disorders, as well as providing new avenues for early intervention and prevention.

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Demographic and clinical characteristics of young people seeking help at youth mental health services: baseline findings of the Transitions Study

Cited by 61 publications

References 41 publications

Can youth at high risk of illness progression be identified by measures of rumination and sleep‐wake disturbance

Can youth at high risk of illness progression be identified by measures of rumination and sleep‐wake disturbance

Beyond the “at risk mental state” concept: transitioning to transdiagnostic psychiatry

Ultra-high-risk paradigm: lessons learnt and new directions

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