Wednesday, August 11, 2021

Criteria for Identifying Youth at High Risk for Psychosis Called Into Question

Sixteen percent of youth under age 18 identified at risk for schizophrenia based on criteria for “at-risk mental state” (ARMS) converted to psychosis within five years, according to a meta-analysis in the Journal of the American Academy of Child and Adolescent Psychiatry. This rate is considerably lower than the rate reported for individuals over 18.

“Our findings indicate a need for caution in applying ARMS methodology to children and adolescents and highlight the need for developmentally sensitive approaches when considering psychosis risk,” wrote senior author Ian Kelleher, M.D., Ph.D., of the Royal College of Surgeons in Ireland and colleagues.

In the past two decades, there has been increasing emphasis on early identification and treatment of young people at risk for schizophrenia and the development of instruments to assess this risk.

Kelleher and colleagues analyzed data from 16 articles based on nine studies reporting psychosis transition rates for 436 youth with ARMS aged 9 to 18 years. Youth were classified as high risk using the Comprehensive Assessment of At Risk Mental States, the Structured Interview for Psychosis Risk Syndromes, the Schizophrenia Proneness Instrument—Child and Youth version, and/or the Bonn Scale for the Assessment of Basic Symptoms.

The authors focused on the proportion of youth who went on to develop psychosis after one, two, and five or more years after designation as high risk. They found the pooled transition rate to psychosis at one year was 9.5%; at two years, 12.1%; and at five years, 16.1%. Those rates are lower than the conversion-to-psychosis rate—29% in three years—reported for adults who had been diagnosed with ARMS, according to the researchers.

Moreover, of 338 young people who experienced a first episode of psychosis, just two had received an ARMS diagnosis before the age of 18 in the only study in the analysis that looked at that association. “This finding suggests that even if highly effective preventive treatments existed, the capacity for psychosis prevention arising from services focusing on children and adolescents with ARMS diagnoses would be very low,” Kelleher and colleagues wrote.

In comments to Psychiatric News, Kelleher said the criteria for identifying at-risk individuals have been developed from research on at-risk adults. “While well intentioned, our findings show that this approach is not appropriate for children and adolescents—we need investment in specialist psychosis risk research and services specifically designed for children and adolescents, where a developmental focus is key,” he said.

For related information, see the Psychiatric News article “New Network Collects Real Time Data to Improve Treatment of Early Psychosis.”

(Image: iStock/Chinnapong)


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