The Cavan-Monaghan First Episode Psychosis Study (CAMFEPS): arbitrary diagnostic boundaries across the gene–environment interface and within evolving models of care

Abstract

As research into psychotic illness evolves along established lines, insights are emerging that deviate from those lines and challenge more fundamentally our understanding. On the background of a new generation of studies on first-episode psychosis, investigations across the gene–environment interface and the intersection with ‘normal’ human mentation heighten these concerns. Using findings from the Cavan-Monaghan First Episode Psychosis Study (CAMFEPS) as an exemplar, we here review the complexity of these challenges from the perspective of this real-world setting. They range from trans-diagnostic epidemiology and clinical characterisation, through molecular genetics, social milieu, developmental pathobiology and functional outcome across arbitrary diagnostic boundaries, to the evidence base for early intervention and more radical conceptualisations and structures for provision of mental health care.

Carepath for overcoming psychosis early (COPE): first 5 years of clinical operation and prospective research in the Cavan–Monaghan early intervention service

“…These findings further elaborate clinical, genetic, and neuroimaging findings that SZ, BD, and MDDP have arbitrary and porous diagnostic boundaries that reflect two realities: first, genetic and environmental factors that interact in a common, transdiagnostic milieu (Brainstorm Consortium, 2018; Castillejos et al 2018; Guloksuz & van Os, 2018; Jongsma et al 2018; Waddington & Russell, 2019); second, dysfunction in one or more components of a common neuronal network that has been implicated in the transdiagnostic pathobiology of SZ, BD, and MDDP (Goodkind et al 2015; Sheffield et al 2017; Baker et al 2018; Ma et al 2019; Tu et al 2019; Huang et al 2020) and extends to both PGMC (Joyce, 2018; Waddington, 2020) and SIP (Khokhar et al 2018).…”

“…As described previously in detail (Waddington & Russell, 2019), in 1995 philanthropic funding allowed the initiation of two parallel studies of first episode psychosis (FEP): one involving the St. John of God Hospitaller Ministries and Cluain Mhuire Community Mental Health Services (hereafter SJoG); the other involving CMMHS and the Royal College of Surgeons in Ireland [hereafter the Cavan–Monaghan First Episode Psychosis Study (CAMFEPS)]. Between 1995 and 1999, these two studies operated in parallel, using overlapping staff training and assessment methods.…”

Can precision medicine advance psychiatry?

“…Any two patients may be assigned an identical diagnosis, but are likely to have distinct psychopathologies requiring different treatments, because psychiatric disorders involve multiple and varying psychosocial and neurobiological routes. By utilizing genomics, proteomics and other associated technological advances, it is possible to build more accurate models of the specific neurochemical abnormalities (Waddington et al 2019). While precision psychiatry, therefore, will not be able to solve the problems of variable and unpredictable response to treatment entirely, the hope is that we can at least improve the odds.…”