Unmet needs for treatment in 102 individuals with brief and limited intermittent psychotic symptoms (BLIPS): implications for current clinical recommendations

Abstract

Aims To investigate clinical outcomes and unmet needs in individuals at Clinical High Risk for Psychosis presenting with Brief and Limited Intermittent Psychotic Symptoms (BLIPS). Methods Prospective naturalistic long-term (up to 9 years) cohort study in individuals meeting BLIPS criteria at the Outreach And Support In South-London (OASIS) up to April 2016. Baseline sociodemographic and clinical characteristics, specific BLIPS features, preventive treatments received and clinical outcomes (psychotic and non-psychotic) were measured. Analyses included Kaplan Meier survival estimates and Cox regression methods. Results One hundred and two BLIPS individuals were followed up to 9 years. Across BLIPS cases, 35% had an abrupt onset; 32% were associated with acute stress, 45% with lifetime trauma and 20% with concurrent illicit substance use. The vast majority (80%) of BLIPS individuals, despite being systematically offered cognitive behavioural therapy for psychosis, did not fully engage with it and did not receive the minimum effective dose. Only 3% of BLIPS individuals received the appropriate dose of cognitive behavioural therapy. At 4-year follow-up, 52% of the BLIPS individuals developed a psychotic disorder, 34% were admitted to hospital and 16% received a compulsory admission. At 3-year follow-up, 52% of them received an antipsychotic treatment; at 4-year follow-up, 26% of them received an antidepressant treatment. The presence of seriously disorganising and dangerous features was a strong poor prognostic factor. Conclusions BLIPS individuals display severe clinical outcomes beyond their very high risk of developing psychosis and show poor compliance with preventive cognitive behavioural therapy. BLIPS individuals have severe needs for treatment that are not met by current preventive strategies.

Impact of coronavirus syndromes on physical and mental health of health care workers: Systematic review and meta-analysis

“…Services for individuals at Clinical High Risk for Psychosis (Fusar-Poli et al, 2020;Kotlicka-Antczak et al, 2020;Salazar de Pablo et al, 2019) may leverage our findings to refine preventive approaches. For example, there is emerging evidence that Covid-19 may increase the incidence of short-lived psychotic episodes (Anmella et al, 2020;Valdés-Florido et al, 2020;Zulkifli et al, 2020) also termed as brief and limited intermittent psychotic symptoms (Castagnini and Fusar-Poli, 2017;Fusar-Poli et al, 2016;Fusar-Poli et al, 2017;Fusar-Poli et al, 2019;Minichino et al, 2019;Rutigliano et al, 2018). Our review found that HCW presented with full-blown disorders as acute stress disorder (Bai et al, 2004) or PTSD (Lee et al, 2018).…”

Brief Psychotic Disorder During the National Lockdown in Italy: An Emerging Clinical Phenomenon of the COVID-19 Pandemic

“… 46 Furthermore, relevant needs of care are currently unmet by preventive strategies for BLIPS individuals, who tend to disengage over time from proposed treatments, such as cognitive behavioral therapy. 47 …”

Acute oxytocin effects in inferring others’ beliefs and social emotions in people at clinical high risk for psychosis

“…CHR-P status was assessed using the Comprehensive Assessment of At-Risk Mental States (CAARMS) 12/2006 criteria 40 . In brief, subjects met one or more of the following subgroup criteria: (a) attenuated psychotic symptoms, (b) brief limited intermittent psychotic symptoms (BLIPS, psychotic episode lasting <1 week, remitting without treatment [41][42][43] ), or (c) either schizotypal personality disorder or firstdegree relative with psychosis 40 , all coupled with functional decline. Individuals were excluded if there was a history of previous psychotic disorder (with the exception of BLIPS, some of whom may meet Acute and Transient Psychotic Disorder criteria 42 ) or manic episode, exposure to antipsychotics, neurological disorder or current substance-use disorder, estimated IQ < 70, acute intoxication on the day of scanning, and any contraindications to MRI or intranasal OT or placebo.…”