Developing services for the early detection of psychosis

Abstract

Recent research has attempted to improve the identification of individuals at-risk of developing schizophrenia to permit targeted early prevention. Two sets of criteria, one characterized by a subgroup of 'basic symptoms' [Klosterkötter, Hellmich, Steinmeyer, Schultze-Lutter (2001) Arch Gen Psychiat 58:158-164] and one by the ultra high-risk model [Miller, McGlashan, Woods, Stein, Driesen, Corcoran, Hoffman, Davidson (1999) Psychiatr Q 70:273-287; Yung, McGorry, McFarlane, Jackson, Patton, Rakkar (1996) Schizophr Bull 22:283-303], have been associated with positive predictive values for later schizophrenia. This paper is a critical discussion of these predictive values. In the first part, the paper demonstrates that the predictive values of at-risk criteria are mediated by a strong enrichment effect and depend considerably on the structure of early detection systems. Further, it shows that these predictive values do not apply to the general population level, where subclinical psychosis shows high prevalence and incidence rates, and that these values may be less predictive in adolescents. In the second part, the paper discusses the need for specific sensitization on several levels of an early detection system and proposes a selected overview of prototypical models already applied in this field.

Help-seeking pathways in early psychosis

“…Although the at-risk criteria applied in the current study are now well-established in the early psychosis research community [26], it may well be possible that not all true at-risk patients meet these criteria. Thus, our study may have only captured a fraction of the individuals developing psychosis [27]. Fourth, we did not control for patient-related factors that may in a large part contribute to referral delays.…”

Mass Murders: Implications for Mental Health Professionals

“…This often involves creating a balance between protecting society and violating the individual's human rights [8]. Actively seeking help for possible symptoms of psychosis or mental illness is a sensitive discriminator between those who do not particularly need to receive at-risk assessments and those who do [13]. Mental health professionals are reminded to consider the possibility of a psychotic disorder if a young person is increasingly socially withdrawn, has deteriorating work or school performance for a sustained period, or is increasingly distressed or agitated without being able to explain why [14].…”