Abstract
The past 20 years have seen the evolution of the construct of a clinical high-risk (hereafter, HR) state for psychosis. This construct is designed to capture the pre-psychotic phase. Some aspects of this approach, such as its feasibility in children and adolescents, are still under investigation. In the present study, we address the feasibility of implementing prodrome clinics for HR individuals within the framework of Italy’s national child and adolescent neuropsychiatry services and the clinical relevance of a HR diagnosis in this population. Using the Comprehensive Assessment of At-Risk Mental States (CAARMS) to identify help-seeking patients meeting at least one HR criterion at baseline (HR+), we recruited 50 subjects for a feasibility study. The results obtained show that the Italian version of the CAARMS is easily administrable, causing patients no substantial discomfort. The prevalence of HR+ in our cohort was 44 %, which increased by an additional 18 % when negative symptoms were considered as an experimental inclusion criterion (HRNeg). The HR+ subjects were significantly more impaired in their social and occupational functioning than their HR− peers (subjects not at HR). The cumulative 1-year transition risk of psychosis of the HR+ group was 26.7 %. When the HRNeg group was added, the 1-year transition risk was 17.3 %. We suggest that administration of the CAARMS to children and adolescents with putative prodromal psychosis is feasible and that this assessment can easily be integrated into existing Italian neuropsychiatry services although clinicians should interpret results with caution as results in this age group still have to be replicated.
Similar content being viewed by others
References
Achenbach TM (1991) Manual for the child behavior checklist/4-18 and 1991 profile. University of Vermont Department of Psychiatry, Burlington
Amminger GP, Leicester S, Yung AR, Phillips LJ, Berger GE, Francey SM, Yuen HP, McGorry PD (2006) Early-onset of symptoms predicts conversion to non-affective psychosis in ultra-high risk individuals. Schizophr Res 84:67–76
APA (2000). Diagnostic and statistical manual of mental disorders, 4th Edn. Text revision. American Psychiatric Association
Bartels-Velthuis AA, van de Willige G, Jenner JA, van Os J, Wiersma D (2011) Course of auditory vocal hallucinations in childhood: 5-year follow-up study. Br J Psychiatry 199:296–302
Bee P, Bower P, Byford S, Churchill R, Calam R, Stallard P, Pryjmachuk S, Berzins K, Cary M, Wan M, Abel K (2014) The clinical effectiveness, cost-effectiveness and acceptability of community-based interventions aimed at improving or maintaining quality of life in children of parents with serious mental illness: a systematic review. Health Technol Assess 18:1–250
Boeing L, Murray V, Pelosi A, McCabe R, Blackwood D, Wrate R (2007) Adolescent-onset psychosis: prevalence, needs and service provision. Br J Psychiatry 190:18–26
Cirino PT, Chin CE, Sevcik RA, Wolf M, Lovett M, Morris RD (2002) Measuring socioeconomic status: reliability and preliminary validity for different approaches. Assessment 9:145–155
Cocchi A, Meneghelli A, Preti A (2008) Programma 2000: celebrating 10 years of activity of an Italian pilot programme on early intervention in psychosis. Aust N Z J Psychiatry 42:1003–1012
Cornblatt B, Lencz T, Obuchowski M (2002) The schizophrenia prodrome: treatment and high-risk perspectives. Schizophr Res 54:177–186
Cornblatt BA, Lencz T, Smith CW, Olsen R, Auther AM, Nakayama E, Lesser ML, Tai JY, Shah MR, Foley CA, Kane JM, Correll CU (2007) Can antidepressants be used to treat the schizophrenia prodrome? Results of a prospective, naturalistic treatment study of adolescents. J Clin Psychiatry 68:546–557
Correll CU, Hauser M, Auther AM, Cornblatt BA (2010) Research in people with psychosis risk syndrome: a review of the current evidence and future directions. J Child Psychol Psychiatry 51:390–431
Fiori Nastro P, Schimmelmann BG, Gebhardt E, Monducci E, Resch F, Koch E, Schultze-Lutter F (2012) Challenges in the early detection of psychosis in children and adolescents. Riv Psychiatry 47:116–125
First MB, Spitzer RL, Williams Jbw (1996) Structured clinical interview for DSM-IV axis I disorders: nonpatient edition (SCID-I/NP). Biometrics Research Department, New York State Psychiatric Institute, New York
Fisher HL, Caspi A, Poulton R, Meier MH, Houts R, Harrington H, Arseneault L, Moffitt TE (2013) Specificity of childhood psychotic symptoms for predicting schizophrenia by 38 years of age: a birth cohort study. Psychol Med 43:2077–2086
Foster K, O’Brien L, Korhonen T (2012) Developing resilient children and families when parents have mental illness: a family-focused approach. Int J Ment Health Nurs 21:3–11
Fusar-Poli P, Bechdolf A, Taylor MJ, Bonoldi I, Carpenter WT, Yung AR, McGuire P (2013) At risk for schizophrenic or affective psychoses? A meta-analysis of DSM/ICD diagnostic outcomes in individuals at high clinical risk. Schizophr Bull 39:923–932
Fusar-Poli P, Bonoldi I, Yung AR, Borgwardt S, Kempton MJ, Valmaggia L, Barale F, Caverzasi E, McGuire P (2012) Predicting psychosis: meta-analysis of transition outcomes in individuals at high clinical risk. Arch Gen Psychiatry 69:220–229
Fusar-Poli P, Borgwardt S (2007) Integrating the negative psychotic symptoms in the high risk criteria for the prediction of psychosis. Med Hypotheses 69:959–960
Fusar-Poli P, Borgwardt S, Bechdolf A, Addington J, Riecher-Rossler A, Schultze-Lutter F, Keshavan M, Wood S, Ruhrmann S, Seidman LJ, Valmaggia L, Cannon T, Velthorst E, De Haan L, Cornblatt B, Bonoldi I, Birchwood M, McGlashan T, Carpenter W, McGorry P, Klosterkotter J, McGuire P, Yung A (2013) The psychosis high-risk state: a comprehensive state-of-the-art review. JAMA Psychiatry 70:107–120
Fusar-Poli P, Byrne M, Badger S, Valmaggia LR, McGuire PK (2013) Outreach and support in south London (OASIS), 2001–2011: 10 years of early diagnosis and treatment for young individuals at high clinical risk for psychosis. Eur Psychiatry 28:315–326
Fusar-Poli P, Byrne M, Valmaggia L, Day F, Tabraham P, Johns L, McGuire P (2010) Social dysfunction predicts 2 years clinical outcome in people at ultra high risk for psychosis. J Psychiatr Res 44:294–301
Fusar-Poli P, Carpenter WT, Woods SW, McGlashan TH (2014) Attenuated psychosis syndrome: ready for DSM-5.1? Annu Rev Clin Psychol
Fusar-Poli P, Hobson R, Raduelli M, Balottin U (2012) Reliability and validity of the comprehensive assessment of the at risk mental state, Italian version (CAARMS-I). Curr Pharm Des 18:386–391
Fusar-Poli P, Nelson B, Valmaggia L, Yung AR, McGuire PK (2014) Comorbid depressive and anxiety disorders in 509 individuals with an at-risk mental state: impact on psychopathology and transition to psychosis. Schizophr Bull 40:120–131
Fusar-Poli P, Van Os J (2013) Lost in transition: setting the psychosis threshold in prodromal research. Acta Psychiatr Scand 127:248–252
Fusar-Poli P, Yung AR, McGorry P, van Os J (2014) Lessons learned from the psychosis high-risk state: towards a general staging model of prodromal intervention. Psychol Med 44:17–24
Fux L, Walger P, Schimmelmann BG, Schultze-Lutter F (2013) The Schizophrenia proneness instrument, child and youth version (SPI-CY): practicability and discriminative validity. Schizophr Res 146:69–78
Goldman HH, Skodol AE, Lave TR (1992) Revising axis V for DSM-IV: a review of measures of social functioning. Am J Psychiatry 149:1148–1156
Gore FM, Bloem PJ, Patton GC, Ferguson J, Joseph V, Coffey C, Sawyer SM, Mathers CD (2011) Global burden of disease in young people aged 10–24 years: a systematic analysis. Lancet 377:2093–2102
Hutton P, Taylor PJ (2014) Cognitive behavioural therapy for psychosis prevention: a systematic review and meta-analysis. Psychol Med 44:449–468
Joa I, Johannessen JO, Langeveld J, Friis S, Melle I, Opjordsmoen S, Simonsen E, Vaglum P, McGlashan T, Larsen TK (2009) Baseline profiles of adolescent vs. adult-onset first-episode psychosis in an early detection program. Acta Psychiatr Scand 119:494–500
Kaymaz N, Drukker M, Lieb R, Wittchen HU, Werbeloff N, Weiser M, Lataster T, van Os J (2012) Do subthreshold psychotic experiences predict clinical outcomes in unselected non-help-seeking population-based samples? A systematic review and meta-analysis, enriched with new results. Psychol Med 42:2239–2253
Kelleher I, Connor D, Clarke MC, Devlin N, Harley M, Cannon M (2012) Prevalence of psychotic symptoms in childhood and adolescence: a systematic review and meta-analysis of population-based studies. Psychol Med 42:1857–1863
Kelleher I, Keeley H, Corcoran P, Lynch F, Fitzpatrick C, Devlin N, Molloy C, Roddy S, Clarke MC, Harley M, Arseneault L, Wasserman C, Carli V, Sarchiapone M, Hoven C, Wasserman D, Cannon M (2012) Clinicopathological significance of psychotic experiences in non-psychotic young people: evidence from four population-based studies. Br J Psychiatry 201:26–32
Kelleher I, Murtagh A, Clarke MC, Murphy J, Rawdon C, Cannon M (2013) Neurocognitive performance of a community-based sample of young people at putative ultra high risk for psychosis: support for the processing speed hypothesis. Cognit Neuropsychiatry 18:9–25
Kelleher I, Murtagh A, Molloy C, Roddy S, Clarke MC, Harley M, Cannon M (2012) Identification and characterization of prodromal risk syndromes in young adolescents in the community: a population-based clinical interview study. Schizophr Bull 38:239–246
Kovacs M (1985) The children’s depression, inventory (CDI). Psychopharmacol Bull 21:995–998
Lencz T, Smith CW, Auther A, Correll CU, Cornblatt B (2004) Nonspecific and attenuated negative symptoms in patients at clinical high-risk for schizophrenia. Schizophr Res 68:37–48
Maffei C, Fossati A, Agostoni I, Barraco A, Bagnato M, Deborah D, Namia C, Novella L, Petrachi M (1997) Interrater reliability and internal consistency of the structured clinical interview for DSM-IV axis II personality disorders (SCID-II), version 2.0. J Pers Disord 11:279–284
Mishara AL, Fusar-Poli P (2013) The phenomenology and neurobiology of delusion formation during psychosis onset: Jaspers, Truman symptoms, and aberrant salience. Schizophr Bull 39:278–286
Murray CJ (1996) Summary: the golbal burden of disease: a comprehensive assessment of mortality and disability from diseases, injuries, and risk factors in 1990 and projected to 2020. Harvard University Press, Cambridge
Nelson B, Fusar-Poli P, Yung AR (2012) Can we detect psychotic-like experiences in the general population? Curr Pharm Des 18:376–385
Nilsson S, Gustafsson L, Nolbris MJ (2014) Young adults’ childhood experiences of support when living with a parent with a mental illness. J Child Health Care
Olvet DM, Stearns WH, McLaughlin D, Auther AM, Correll CU, Cornblatt BA (2010) Comparing clinical and neurocognitive features of the schizophrenia prodrome to the bipolar prodrome. Schizophr Res 123:59–63
Pihkala H, Sandlund M, Cederstrom A (2012) Initiating communication about parental mental illness in families: an issue of confidence and security. Int J Soc Psychiatry 58:258–265
Piskulic D, Addington J, Cadenhead KS, Cannon TD, Cornblatt BA, Heinssen R, Perkins DO, Seidman LJ, Tsuang MT, Walker EF, Woods SW, McGlashan TH (2012) Negative symptoms in individuals at clinical high risk of psychosis. Psychiatry Res 196:220–224
Puig-Antich J, Rabinovich H (1986) The schedule for affective disorders and Schizophrenia for school-age children (Kiddie-SADS). Western Psychiatric Institute and Clinic, Pittsburgh
Raven J (2000) The Raven’s progressive matrices: change and stability over culture and time. Cogn Psychol 41:1–48
Rubio JM, Sanjuan J, Florez-Salamanca L, Cuesta MJ (2012) Examining the course of hallucinatory experiences in children and adolescents: a systematic review. Schizophr Res 138:248–254
Schimmelmann BG, Walger P, Schultze-Lutter F (2013) The significance of at-risk symptoms for psychosis in children and adolescents. Can J Psychiatry Revue Canadienne de Psychiatrie 58:32–40
Schultze-Lutter F, Michel C, Ruhrmann S, Schimmelmann BG (2014) Prevalence and clinical significance of DSM-5-attenuated psychosis syndrome in adolescents and young adults in the general population: the Bern Epidemiological At-Risk (BEAR) study. Schizophr Bull 40:1499–1508
Schultze-Lutter F, Michel C, Schmidt SJ, Schimmelmann BG, Maric NP, Salokangas RK, Riecher-Rossler A, van der Gaag M, Nordentoft M, Raballo A, Meneghelli A, Marshall M, Morrison A, Ruhrmann S, Klosterkotter J (2015) EPA guidance on the early detection of clinical high risk states of psychoses. Eur Psychiatry
Schultze-Lutter F, Ruhrmann S, Fusar-Poli P, Bechdolf A, Schimmelmann BG, Klosterkotter J (2012) Basic symptoms and the prediction of first-episode psychosis. Curr Pharm Des 18:351–357
Schultze-Lutter F, Schimmelmann BG, Ruhrmann S (2011) The near Babylonian speech confusion in early detection of psychosis. Schizophr Bull 37:653–655
Seidman LJ, Giuliano AJ, Meyer EC, Addington J, Cadenhead KS, Cannon TD, McGlashan TH, Perkins DO, Tsuang MT, Walker EF, Woods SW, Bearden CE, Christensen BK, Hawkins K, Heaton R, Keefe RS, Heinssen R, Cornblatt BA (2010) Neuropsychology of the prodrome to psychosis in the NAPLS consortium: relationship to family history and conversion to psychosis. Arch Gen Psychiatry 67:578–588
van Wijngaarden B, Schene AH, Koeter MW (2004) Family caregiving in depression: impact on caregivers’ daily life, distress, and help seeking. J Affect Disord 81:211–222
Wechsler D (1997) WAIS-R Wechsler Adult Intelligence Scale—Revised. Giunti OS
Wechsler, D (2006) WISC-III Wechsler Intelligence Scale for Children—III La terza edizione di uno dei più grandi successi della psicodiagnostica. Giunti OS
Wechsler, D (2012) WISC-IV Wechsler Intelligence Scale for Children-IV Nuovo modello teorico, nuovi subtest, nuovi punteggi, nuove norme: il perfezionamento dell’eccellenza. Giunti OS
Welsh P, Tiffin PA (2013) The ‘at-risk mental state’ for psychosis in adolescents: clinical presentation, transition and remission. Child Psychiatry Hum Dev
Wolpert M, Hoffman J, Martin A, Fagin L, Cooklin A (2014) An exploration of the experience of attending the Kidstime programme for children with parents with enduring mental health issues: Parents’ and young people’s views. Clin Child Psychol Psychiatry
Woods SW, Addington J, Cadenhead KS, Cannon TD, Cornblatt BA, Heinssen R, Perkins DO, Seidman LJ, Tsuang MT, Walker EF, McGlashan TH (2009) Validity of the prodromal risk syndrome for first psychosis: findings from the North American Prodrome Longitudinal Study. Schizophr Bull 35:894–908
Yung AR, McGorry PD (1996) The initial prodrome in psychosis: descriptive and qualitative aspects. Aust N Z J Psychiatry 30:587–599
Yung AR, McGorry PD (1996) The prodromal phase of first-episode psychosis: past and current conceptualizations. Schizophr Bull 22:353–370
Yung AR, Nelson B, Stanford C, Simmons MB, Cosgrave EM, Killackey E, Phillips LJ, Bechdolf A, Buckby J, McGorry PD (2008) Validation of “prodromal” criteria to detect individuals at ultra high risk of psychosis: 2 year follow-up. Schizophr Res 105:10–17
Yung AR, Yuen HP, McGorry PD, Phillips LJ, Kelly D, Dell’Olio M, Francey SM, Cosgrave EM, Killackey E, Stanford C, Godfrey K, Buckby J (2005) Mapping the onset of psychosis: the comprehensive assessment of at-risk mental states. Aust N Z J Psychiatry 39:964–971
Ziermans TB, Schothorst PF, Sprong M, van Engeland H (2011) Transition and remission in adolescents at ultra-high risk for psychosis. Schizophr Res 126:58–64
Acknowledgments
The project was funded by Italian Ministry of Education, University and Research (MIUR).
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical standards
Our study was approved by the ethics committee of our institute and was therefore performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All study participants gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study were omitted.
Author information
Authors and Affiliations
Corresponding author
Additional information
Paolo Fusar-Poli and Umberto Balottin are joint last authors.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Spada, G., Molteni, S., Pistone, C. et al. Identifying children and adolescents at ultra high risk of psychosis in Italian neuropsychiatry services: a feasibility study. Eur Child Adolesc Psychiatry 25, 91–106 (2016). https://doi.org/10.1007/s00787-015-0710-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00787-015-0710-8