Onset and transition of and recovery from adverse development: Study methodology

Abstract

Aim Early intervention programs for first‐episode psychosis have led to the awareness that the period before onset of a first episode is important in light of early intervention. This has induced a focus on the so‐called ‘at risk mental state’ (ARMS). Individuals with ARMS are at increased risk for later psychotic disorder, but also for other psychiatric disorders as well as poor psychosocial functioning. Thus, adequate detection and treatment of ARMS is essential. Methods Since 2018, screening for and treatment of ARMS is recommended standard care in the Netherlands. Implementation is still ongoing. We initiated a naturalistic long‐term cohort study of ARMS individuals, the onset and transition of and recovery from adverse development (OnTheROAD) study, with the aim to monitor course and outcome of symptoms and psychosocial functioning over time, as well as patterns of comorbidity and associations with factors of risk and resilience. To this end, participants complete a broad battery of instruments at baseline and yearly follow‐up assessments up to 3 years. Outcome is defined in terms of symptom severity level, functioning and quality of life. In particular, we aim to investigate the impact of negative symptoms as part of the ARMS concept. Results from this study can aid in refining the existing ARMS criteria, understanding the developmental course of ARMS and investigating the hypothesized pluripotentiality in outcome of ARMS. New knowledge may inform the further development of specialized early interventions. Results and Conclusions In this article, we describe the rationale, outline and set‐up of OnTheROAD.

Early expressions of psychopathology and risk associated with trans-diagnostic transition to mood and psychotic disorders in adolescents and young adults

“…To enhance options for prevention, we need greater knowledge not only of which ‘at risk’ individuals are most likely to transition to full threshold caseness, but also to develop screening procedures that capture the warning signs and symptoms during the specific timeframe when a ‘risk syndrome’ is most likely to evolve into a severe, impairing, or distressing condition [ 29 – 31 ]. The need to extend trans-diagnostic approaches is recognized in the literature [ 2 , 5 , 27 , 39 ] and in published protocols for future prospective research [ 16 , 35 , 36 , 38 ]. These all acknowledge that FH is an established marker of risk and emphasize that there is no rationale to recommend discontinuing its recording.…”

Reflections on psychological resilience: a comparison of three conceptually different operationalizations in predicting mental health

“…Allocation to subgroup 2, 3 or 4 was based on the level of psychotic experiences, which served as an indicator of risk for developing psychosis. Subgroup allocation was based on early detection practices in which all newly referred mental health care patients are screened for psychotic symptomatology, regardless of the type of symptoms they are referred for (Wigman et al, 2020 ). After screening by the Prodromal Questionnaire (PQ)-16 (Ising et al, 2012 ), participants with a score of <6 (meaning mild, non-psychotic psychopathology) were allocated to subgroup 2.…”

Mental health, risk and protective factors at micro‐ and macro‐levels across early at‐risk stages for psychosis: The Mirorr study

“…However, a broader perspective may deepen our understanding of the different stages and transitions between them. Although characterization of early stages of psychotic expression relies heavily on positive psychotic symptoms (e.g., hearing voices) (Wigman et al, 2020), other symptoms (e.g., anxiety and depression) are also common (Lin et al, 2015; Yung et al, 2007). Therefore, a transdiagnostic approach spanning multiple psychopathological domains seems warranted (McGorry et al, 2018).…”