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Developing services for the early detection of psychosis

A critical consideration of the current state of the art

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Abstract

Recent research has attempted to improve the identification of individuals at-risk of developing schizophrenia to permit targeted early prevention. Two sets of criteria, one characterized by a subgroup of ‘basic symptoms’ [Klosterkötter, Hellmich, Steinmeyer, Schultze-Lutter (2001) Arch Gen Psychiat 58:158–164] and one by the ultra high-risk model [Miller, McGlashan, Woods, Stein, Driesen, Corcoran, Hoffman, Davidson (1999) Psychiatr Q 70:273–287; Yung, McGorry, McFarlane, Jackson, Patton, Rakkar (1996) Schizophr Bull 22:283–303], have been associated with positive predictive values for later schizophrenia. This paper is a critical discussion of these predictive values. In the first part, the paper demonstrates that the predictive values of at-risk criteria are mediated by a strong enrichment effect and depend considerably on the structure of early detection systems. Further, it shows that these predictive values do not apply to the general population level, where subclinical psychosis shows high prevalence and incidence rates, and that these values may be less predictive in adolescents. In the second part, the paper discusses the need for specific sensitization on several levels of an early detection system and proposes a selected overview of prototypical models already applied in this field.

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Acknowledgements

We gratefully acknowledge Frauke Schultze-Lutter, University of Cologne, Germany, for training in ‘basic symptoms’ and UHR ratings. The Bruderholz Study is supported by an educational grant from the Freiwillige Akademische Gesellschaft Basel (FAG), Switzerland, and from the Stiftung für Gesundheitsförderung, Baselland, Switzerland. The pilot phase of this study was supported by an unrestricted grant from Astra Zeneca, Switzerland.

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Authors and Affiliations

  1. Department of Psychiatry, Specialized Outpatient Clinic for Early Psychosis, Psychiatric Outpatient Services, 4101, Bruderholz, Switzerland

    Andor E. Simon MD

  2. Department of Psychiatry, Child and Adolescent Psychiatric Department, 4101, Bruderholz, Switzerland

    Binia Roth, Solange Zmilacher & Emanuel Isler

  3. Translational Medicine Neuroscience, Exploratory Development, Novartis Pharma AG, 4056, Basel, Switzerland

    Daniel Umbricht

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  1. Andor E. Simon MD
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Correspondence to Andor E. Simon MD.

Additional information

The contents of this paper were presented at the 48th Annual Conference of the Swiss Society of Child and Youth Psychiatry, Münsterlingen, Switzerland, 4th November 2005

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Simon, A.E., Roth, B., Zmilacher, S. et al. Developing services for the early detection of psychosis. Eur Child Adolesc Psychiatry 16, 96–103 (2007). https://doi.org/10.1007/s00787-006-0579-7

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