Genealogy of instruments for prodrome evaluation of psychosis

Abstract

Objective: Over the last 15 years, researchers from around the world have developed instruments for assessing the risk of conversion to psychosis. The objective of this article is to review the literature on these instruments by focusing on genealogy links and on their performance in predicting conversion to psychosis.Method: A systematic review of articles published since 1980 relating to risk assessment instruments for conversion to psychosis by manual search and consultation of electronic databases MEDLINE, EMBASE, and PsycINFO.Results: Three hundred ninety one (391) publications were selected and analyzed. Among these, 22 instruments were identified. These instruments are briefly described and placed on a timeline according to their year of publication. A code of positions, patterns, and forms is used to schematize the characteristics of each instrument. A table is presented to show changes in rates of conversion to psychosis within cohorts of subjects considered at risk according to the instruments. A second code of shades and outlines is used to schematize the characteristics of each cohort of patients. The two graphics set the stage for a discussion about the major strategies that were adopted to improve the performance of risk assessment instruments.Conclusion: These graphics allow a better understanding of the origin, evolution, current status, strengths, shortcomings, and future prospects of research on risk assessment instruments.Clinical Implications The integration of theoretical approaches, the multicenter studies, and the pre-selection of patients with short questionnaires were the main strategies to improve the performance of instruments assessing the risk of conversion to psychosis.These instruments are better at predicting conversion to psychosis than conventional variables within a more limited time span and can therefore enable the evaluation of various risk factors and biomarkers that may be associated with psychosis.Limitations The studies selected for this review of literature were not classified according to their methodological quality.These studies are based on heterogeneous populations and this must be taken into account when comparing the rates of conversion to psychosis.This review of literature was based on published data only and they were no direct communication with the authors of these instruments.

Brain structure in people at ultra-high risk of psychosis, patients with first-episode schizophrenia, and healthy controls: a VBM study

“…Also, lack of longitudinal data did not allow us to assess the factor of later conversion to psychosis, which might be considered in a larger cohort analysis. Different approaches to classifying ultra-high risk subjects will obviously also have an impact on classification of subgroups (on clinical grounds); yet, our use of CAARMS has the advantage of applying one of the best validated instruments in the field (Daneault et al, 2013).…”

“…There are now wellvalidated clinical instruments (Daneault et al, 2013), which have been used to screen young people at high risk for later onset of psychosis, both with the aim of identifying early intervention strategies, as well as enabling biological research into well-defined high-risk populations. Most of these assessments rely on clinical signs and symptoms, including basic symptoms, the occurrence of brief or attenuated psychotic symptoms, psychometric schizotypy, or biological factors such as familial liability (Addington and Heinssen, 2012;Schultze-Lutter et al, 2012;Daneault et al, 2013). Among the most widely used clinical and research instruments, the CAARMS interview (comprehensive assessment of at-risk mental state (Yung et al, 2002)), for example, considers several clinical factors, including higher genetic load (e.g.…”

“…first-degree relatives of patients with schizophrenia with drop in functioning), attenuated psychotic symptoms, or brief self-limiting intermittent psychotic symptoms (BLIPS). Any of these factors or "routes" towards an at-risk mental state (ARMS) is considered, and screened subjects might meet criteria for ARMS based on one or more of these aspects (Yung et al, 2002;Daneault et al, 2013). People at ultra-high risk (UHR) for psychosis can therefore be assumed to be a heterogeneous group, independent of whether they eventually convert to schizophrenia or develop another psychiatric condition, since they vary in degrees of genetic liability, symptom profiles, and other phenotypic variables such as cognitive function (Kohler et al, 2014).…”

The Reliability and Validity of Liu´s Self-Report Questionnaire for Screening Putative Pre-Psychotic States (BQSPS) in Adolescents

“…Daneault et al [11] identified 22 instruments with the most widely used measures being clinician administered interviews addressing previously well-validated clinical high-risk criteria [12]. The prognostic accuracy of these thorough psychometric measures is sufficient for help-seeking subjects with psychiatric symptoms [2].…”

Electrophysiological, cognitive and clinical profiles of at-risk mental state: The longitudinal Minds in Transition (MinT) study

“…Internationally, a number of clinical instruments have been devised to identify individuals who are at risk of developing a psychotic illness. These instruments differ in the extent to which they monitor attenuated psychotic symptoms, basic symptoms, and functional status [3]. The Comprehensive Assessment of At Risk Mental State (CAARMS) is a structured interview designed to identify individuals considered to be at ultra-high risk (UHR) of developing psychosis [4].…”