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

Schultze-Lutter, Frauke; Michel, Chantal; Schmidt, Stefanie Julia; Schimmelmann, Benno Karl Edgar; Maric, N.P.; Salokangas, R.K.R.; Riecher-Rössler, A.; van der Gaag, M.; Nordentoft, M.; Raballo, A.; Meneghelli, A.; Marshall, M.; Morrison, A.; Ruhrmann, S.; Klosterkötter, J. (2015). EPA guidance on the early detection of clinical high risk states of psychoses. European psychiatry, 30(3), pp. 405-416. Elsevier Masson SAS 10.1016/j.eurpsy.2015.01.010

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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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > University Psychiatric Services > University Hospital of Child and Adolescent Psychiatry and Psychotherapy
04 Faculty of Medicine > University Psychiatric Services

UniBE Contributor:

Schultze-Lutter, Frauke; Michel, Chantal; Schmidt, Stefanie Julia and Schimmelmann, Benno Karl Edgar

Subjects:

100 Philosophy > 150 Psychology
600 Technology > 610 Medicine & health

ISSN:

0924-9338

Publisher:

Elsevier Masson SAS

Language:

English

Submitter:

Nicole Jansen

Date Deposited:

18 May 2015 14:40

Last Modified:

11 Nov 2015 11:38

Publisher DOI:

10.1016/j.eurpsy.2015.01.010

PubMed ID:

25735810

BORIS DOI:

10.7892/boris.68281

URI:

https://boris.unibe.ch/id/eprint/68281

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