title: Detection of people at risk of developing a first psychosis: comparison of two recruitment strategies.
abstract: OBJECTIVE
  Better recruitment strategies are needed to improve the identification of people at ultra-high risk of developing psychosis. This study explores the effectiveness of two recruitment strategies: a screening method in a consecutive help-seeking population entering secondary mental health services for non-psychotic problems vs. a population referred to the diagnostic center of an early-psychosis clinic.
  
  
  METHODS
  From February 2008 to February 2010, all general practitioner and self-referrals (aged 18-35 years) to the secondary mental healthcare service in The Hague and Zoetermeer were screened with the Prodromal Questionnaire; patients who scored above the cutoff of 18 and had a decline in social functioning were assessed using the Comprehensive Assessment of At-Risk Mental States (CAARMS). All referrals (aged 14-35 years) to the diagnostic center in Amsterdam were also assessed with the CAARMS.
  
  
  RESULTS
  The screening detected a three-fold higher prevalence of at-risk mental states: these subjects were older and more often female. manova showed significantly higher scores for the screened population on depression, social anxiety, distress with positive symptoms, and a higher rate of transition to psychosis within 12 months.
  
  
  CONCLUSIONS
  The screening method detects more patients with at-risk mental states than the referral method. The latter method is biased to young male patients in an earlier prodromal stage and a lower transition rate.
authors.affiliation: Department of Clinical Psychology, VU University Amsterdam, the Netherlands. judithrietdijk@gmail.com
authors.forename: J
authors.initials: J
authors.lastname: Rietdijk
authors.forename: R
authors.initials: R
authors.lastname: Klaassen
authors.forename: H
authors.initials: H
authors.lastname: Ising
authors.forename: S
authors.initials: S
authors.lastname: Dragt
authors.forename: D H
authors.initials: DH
authors.lastname: Nieman
authors.forename: J
authors.initials: J
authors.lastname: van de Kamp
authors.forename: P
authors.initials: P
authors.lastname: Cuijpers
authors.forename: D
authors.initials: D
authors.lastname: Linszen
authors.forename: M
authors.initials: M
authors.lastname: van der Gaag
mesh_terms: D000293:Adolescent; D000328:Adult; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D010342:Patient Acceptance of Health Care / Q000523:psychology; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000175:diagnosis*; D012307:Risk Factors; D055815:Young Adult