Identifying children and adolescents at ultra high risk of psychosis in Italian neuropsychiatry services: a feasibility study.
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.
Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK. giulia.spada@kcl.ac.uk.|OASIS Prodromal Team, South London and the Maudsley (SLaM) NHS Foundation Trust, London, UK. giulia.spada@kcl.ac.uk.|Child Neuropsychiatry Unit, Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy. giulia.spada@kcl.ac.uk.
Giulia
G
Spada
Child Neuropsychiatry Unit, Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy.
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S
Molteni
Child Neuropsychiatry Unit, Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy.
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C
Pistone
Child Neuropsychiatry Unit, C. Mondino National Neurological Institute, Pavia, Italy.
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M
Chiappedi
Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK.|OASIS Prodromal Team, South London and the Maudsley (SLaM) NHS Foundation Trust, London, UK.
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P
McGuire
Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK.|OASIS Prodromal Team, South London and the Maudsley (SLaM) NHS Foundation Trust, London, UK.
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Fusar-Poli
Child Neuropsychiatry Unit, Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy.|Child Neuropsychiatry Unit, C. Mondino National Neurological Institute, Pavia, Italy.
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U
Balottin
D000293:Adolescent; D002648:Child; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008605:Mental Health Services / Q000592:standards* / Q000639:trends; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales / Q000592:standards*; D011618:Psychotic Disorders / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D018570:Risk Assessment; D012307:Risk Factors
Adolescents; Children; Psychosis; Psychosis risk; Schizophrenia