EPA guidance on the early detection of clinical high risk states of psychoses

TY - JOUR

T1 - EPA guidance on the early detection of clinical high risk states of psychoses

AU - Schultze-Lutter, F

AU - Michel, C

AU - Schmidt, S J

AU - Schimmelmann, B G

AU - Maric, N P

AU - Salokangas, R K R

AU - Riecher-Rössler, A

AU - van der Gaag, M

AU - Nordentoft, M

AU - Raballo, A

AU - Meneghelli, A

AU - Marshall, M

AU - Morrison, A

AU - Ruhrmann, S

AU - Klosterkötter, J

N1 - Copyright © 2015 Elsevier Masson SAS. All rights reserved.

PY - 2015/3/1

Y1 - 2015/3/1

N2 - The aim of this guidance paper of the European Psychiatric Association is to provide evidence-based recommendations on the early detection of a clinical high risk (CHR) for psychosis in patients with mental problems. To this aim, we conducted a meta-analysis of studies reporting on conversion rates to psychosis in non-overlapping samples meeting any at least any one of the main CHR criteria: ultra-high risk (UHR) and/or basic symptoms criteria. Further, effects of potential moderators (different UHR criteria definitions, single UHR criteria and age) on conversion rates were examined. Conversion rates in the identified 42 samples with altogether more than 4000 CHR patients who had mainly been identified by UHR criteria and/or the basic symptom criterion 'cognitive disturbances' (COGDIS) showed considerable heterogeneity. While UHR criteria and COGDIS were related to similar conversion rates until 2-year follow-up, conversion rates of COGDIS were significantly higher thereafter. Differences in onset and frequency requirements of symptomatic UHR criteria or in their different consideration of functional decline, substance use and co-morbidity did not seem to impact on conversion rates. The 'genetic risk and functional decline' UHR criterion was rarely met and only showed an insignificant pooled sample effect. However, age significantly affected UHR conversion rates with lower rates in children and adolescents. Although more research into potential sources of heterogeneity in conversion rates is needed to facilitate improvement of CHR criteria, six evidence-based recommendations for an early detection of psychosis were developed as a basis for the EPA guidance on early intervention in CHR states.

AB - The aim of this guidance paper of the European Psychiatric Association is to provide evidence-based recommendations on the early detection of a clinical high risk (CHR) for psychosis in patients with mental problems. To this aim, we conducted a meta-analysis of studies reporting on conversion rates to psychosis in non-overlapping samples meeting any at least any one of the main CHR criteria: ultra-high risk (UHR) and/or basic symptoms criteria. Further, effects of potential moderators (different UHR criteria definitions, single UHR criteria and age) on conversion rates were examined. Conversion rates in the identified 42 samples with altogether more than 4000 CHR patients who had mainly been identified by UHR criteria and/or the basic symptom criterion 'cognitive disturbances' (COGDIS) showed considerable heterogeneity. While UHR criteria and COGDIS were related to similar conversion rates until 2-year follow-up, conversion rates of COGDIS were significantly higher thereafter. Differences in onset and frequency requirements of symptomatic UHR criteria or in their different consideration of functional decline, substance use and co-morbidity did not seem to impact on conversion rates. The 'genetic risk and functional decline' UHR criterion was rarely met and only showed an insignificant pooled sample effect. However, age significantly affected UHR conversion rates with lower rates in children and adolescents. Although more research into potential sources of heterogeneity in conversion rates is needed to facilitate improvement of CHR criteria, six evidence-based recommendations for an early detection of psychosis were developed as a basis for the EPA guidance on early intervention in CHR states.

KW - Adolescent

KW - Adult

KW - Antipsychotic Agents

KW - Child

KW - Cognition Disorders

KW - Early Diagnosis

KW - Early Medical Intervention

KW - Female

KW - Humans

KW - Male

KW - Mood Disorders

KW - Practice Guidelines as Topic

KW - Psychiatric Status Rating Scales

KW - Psychotic Disorders

KW - Risk Assessment

KW - Risk Factors

KW - Schizophrenia

KW - Treatment Outcome

KW - Young Adult

U2 - 10.1016/j.eurpsy.2015.01.010

DO - 10.1016/j.eurpsy.2015.01.010

M3 - Journal article

C2 - 25735810

SN - 0924-9338

VL - 30

SP - 405

EP - 416

JO - European Psychiatry

JF - European Psychiatry

IS - 3

ER -