Transdiagnostic clinical staging in youth mental health: a first international consensus statement

Shah, Jai; Scott, Jan; McGorry, Patrick D.; Cross, Shane; Keshavan, Matcheri S.; Nelson, Barnaby; Wood, Stephen; Marwaha, Steven; Yung, Alison; Scott, Elizabeth; Öngür, Döst; Conus, Philippe; Henry, Chantal; Hickie, Ian B.

doi:10.1002/wps.20745

Cited by 194 publications

(197 citation statements)

References 64 publications

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“…This approach acknowledges the fluid and dynamic nature of the onset and early stages of mental ill‐health, during which microphenotypes ebb and flow, and either fade or evolve into a more stable syndrome or more commonly syndromes (Figure 1). Primary psychosis is one of these syndromes, one that typically emerges from earlier stages which already display a need for care, and attracts additional comorbid syndromes and functional impairment 177 .…”

Section: Clinical Stagingmentioning

confidence: 99%

The clinical characterization of the patient with primary psychosis aimed at personalization of management

et al. 2021

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The current management of patients with primary psychosis worldwide is often remarkably stereotyped. In almost all cases an antipsychotic medication is prescribed, with second‐generation antipsychotics usually preferred to first‐generation ones. Cognitive behavioral therapy is rarely used in the vast majority of countries, although there is evidence to support its efficacy. Psychosocial interventions are often provided, especially in chronic cases, but those applied are frequently not validated by research. Evidence‐based family interventions and supported employment programs are seldom implemented in ordinary practice. Although the notion that patients with primary psychosis are at increased risk for cardiovascular diseases and diabetes mellitus is widely shared, it is not frequent that appropriate measures be implemented to address this problem. The view that the management of the patient with primary psychosis should be personalized is endorsed by the vast majority of clinicians, but this personalization is lacking or inadequate in most clinical contexts. Although many mental health services would declare themselves “recovery‐oriented”, it is not common that a focus on empowerment, identity, meaning and resilience is ensured in ordinary practice. The present paper aims to address this situation. It describes systematically the salient domains that should be considered in the characterization of the individual patient with primary psychosis aimed at personalization of management. These include positive and negative symptom dimensions, other psychopathological components, onset and course, neurocognition and social cognition, neurodevelopmental indicators; social functioning, quality of life and unmet needs; clinical staging, antecedent and concomitant psychiatric conditions, physical comorbidities, family history, history of obstetric complications, early and recent environmental exposures, protective factors and resilience, and internalized stigma. For each domain, simple assessment instruments are identified that could be considered for use in clinical practice and included in standardized decision tools. A management of primary psychosis is encouraged which takes into account all the available treatment modalities whose efficacy is supported by research evidence, selects and modulates them in the individual patient on the basis of the clinical characterization, addresses the patient’s needs in terms of employment, housing, self‐care, social relationships and education, and offers a focus on identity, meaning and resilience.

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Section: Clinical Stagingmentioning

confidence: 99%

The clinical characterization of the patient with primary psychosis aimed at personalization of management

et al. 2021

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“…Although depressive disorders are the most frequent consequence of subclinical depression, it can also lead to other mood disorders. From the clinical staging approach, subclinical depression could be the prodromal stage for a variety of mental health problems ( 7 ). However, studies on subclinical depression mostly focus on preventing the onset of depression, and other mood disorders are commonly overlooked ( 8 , 9 ).…”

Section: Introductionmentioning

confidence: 99%

Efficacy of an Internet-Based Intervention for Subclinical Depression (MoodBox) in China: Study Protocol for a Randomized Controlled Trial

Zhang

Zhu

et al. 2021

Front. Psychiatry

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Background: Subclinical depression is a prevalent mental health problem and increases the incidence of the onset of major mood disorders, such as major depressive disorder (MDD). Psychological interventions have been proved to be effective for reducing depressive symptoms for people with subclinical depression and can prevent the onset of MDD. However, people have limited access to face-to-face psychotherapy. Internet-based psychological intervention is an alternative treatment option. The aim of the study is to evaluate the efficacy of MoodBox, an online psychological intervention program, for subclinical depression.Methods: This study is a multicenter, randomized, controlled, non-blinded superiority study with three parallel groups. A total of 435 first-year university students with subclinical depression will be recruited. Eligible participants will be randomly assigned to the MoodBox group, the online psychoeducation group, and the naturalistic observation group at a ratio of 1:1:1. The intervention period is 8 weeks, and participants will be continuously followed up for 1 year. The primary outcome of the study is the efficacy of the intervention, defined as measured by the Patient Health Questionnaire (PHQ-9).Discussion: This is the first study to innovatively develop and test an intervention to improve psychological well-being and decrease the incidence of MDD in a subclinical depression population in China. Once proven effective and acceptable, MoodBox could be potentially integrated into the routine clinical service to facilitate the management for people with subclinical depression.Clinical Trial Registration: The trial is registered with the Chinese Clinical Trial Registry on 21 July 2020 (No. ChiCTR2000034826).

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“…The complexity and heterogeneity of the evolution of mental disorders presenting during adolescence and early adulthood (i.e., the peak age range for onset of adult-pattern illnesses) has exposed significant concerns regarding the reliability, validity and of traditional diagnoses and the applicability of “disorder-specific” interventions ( 6 ). Many experts suggest employing trans-diagnostic models as a more constructive approach for research, prevention, and clinical treatments ( 6 , 7 ).…”

Section: Introductionmentioning

confidence: 99%

Brief Research Report: A Pilot Study of Cognitive Behavioral Regulation Therapy (CBT-REG) for Young People at High Risk of Early Transition to Bipolar Disorders

Scott

Meyer²

2021

Front. Psychiatry

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Attempts to increase early identification of individuals in the early stages of bipolar disorders (i.e., individuals at high risk of bipolar disorders and/or experiencing a subthreshold syndrome with bipolar symptoms) have highlighted the need to develop high benefit-low risk interventions. We suggest that any new psychological therapy should (i) be acceptable to young people seeking help for the first time, (ii) be applicable to “at risk” conditions and sub-syndromal states and (iii) consider pluripotent factors that may be linked to illness progression not only for bipolar disorders specifically but also for other potential disease trajectories. However, evidence indicates that current interventions for youth with emerging mood disorders mainly represent approaches abbreviated from “disorder-specific” therapies used with older adults and are primarily offered to first episode cases of bipolar disorders who are also receiving psychotropic medication. This brief report discusses empirical findings used to construct core targets for therapeutic interventions that might reduce or delay transition to full-threshold bipolar disorders. We describe an intervention that includes strategies for problem-solving, reducing sleep-wake cycle disturbances, self-management of rumination and that addresses the needs of individuals with “sub-threshold” presentations who are probably at risk of developing a bipolar or other major mental disorders. Outcome data from a case series of 14 youth indicates that the intervention appears to demonstrate a relatively high benefit-to-risk ratio, promising levels of engagement with the therapy modules, and the therapy appears to be acceptable to a wide range of help-seeking youth with early expressions of bipolar psychopathology.

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Transdiagnostic clinical staging in youth mental health: a first international consensus statement

Cited by 194 publications

References 64 publications

The clinical characterization of the patient with primary psychosis aimed at personalization of management

The clinical characterization of the patient with primary psychosis aimed at personalization of management

Efficacy of an Internet-Based Intervention for Subclinical Depression (MoodBox) in China: Study Protocol for a Randomized Controlled Trial

Brief Research Report: A Pilot Study of Cognitive Behavioral Regulation Therapy (CBT-REG) for Young People at High Risk of Early Transition to Bipolar Disorders

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