Skip to main content

Advertisement

SpringerLink
Log in

Evaluating the tendencies of community practitioners who actively practice in child and adolescent psychiatry to diagnose and treat DSM-5 attenuated psychotic syndrome

  • Original Contribution
  • Published:
European Child & Adolescent Psychiatry Aims and scope Submit manuscript

Abstract

The detection of individuals at clinical ultra-high risk for psychosis (CHR-P) may be a key limiting step for early interventions, and there is some uncertainty regarding the true clinical reliability of the CHR-P states. The aim of this study was to explore how practitioners who were in the direct treatment of children with psychiatric disorders [child psychiatry specialists/trainees (n = 227, n = 131), adult psychiatrists (n = 27), and child neurologists (n = 2)] perceive the DSM-5-Attenuated Psychosis Syndrome (DSM-5-APS), and their clinical routine practice in the treatment of it. Three vignettes describing fictional cases presented with symptoms of either DSM-5-Schizophrenia, DSM-5-APS, and no psychotic symptoms were created. We asked these practitioners to apply a DSM-5 diagnosis and to choose appropriate treatment(s) for these vignettes. Of the responders, 43% correctly diagnosed the APS vignette, whereas 37.4% mentioned that it had a full-blown psychotic episode. Regarding the therapeutic approach for the APS vignette, 72.1% of all practitioners chose a psychopharmacological intervention and 32% individual psychotherapy. This study showed that the diagnostic inter-rater reliability of the DSM-5-APS among child/adolescent mental health practitioners was consistent with the results from the DSM-5 field trials (Kappa = 0.46). Moreover, almost three in four practitioners endorsed psychopharmacological intervention as a treatment option for the DSM-5-APS case. The lack of evidence of psychopharmacological interventions in CHR-P situations emphasizes that the least harmful interventions should be recommended. Thus, our findings indicated a need for raising awareness regarding the CHR-P paradigm and its treatment as well as the development of solid guidelines that can be implemented in clinical practice.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Availability of data and materials

Not applicable.

Code availability

Not applicable.

References

  1. Association AP (2013) Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub, Washington DC

    Book  Google Scholar 

  2. Bora E (2015) Neurodevelopmental origin of cognitive impairment in schizophrenia. Psychol Med 45:1–9. https://doi.org/10.1017/S0033291714001263

    Article  CAS  PubMed  Google Scholar 

  3. Keefe RSE, Harvey PD (2012) Cognitive impairment in schizophrenia. In: Geyer MA, Gross G (eds) Novel antischizophrenia treatments. Springer Berlin Heidelberg, Berlin, Heidelberg, pp 11–37

    Chapter  Google Scholar 

  4. van Os J, Kapur S (2009) Schizophrenia. Lancet 374:635–645. https://doi.org/10.1016/S0140-6736(09)60995-8

    Article  CAS  PubMed  Google Scholar 

  5. Kafali HY, Bildik T, Bora E et al (2019) Distinguishing prodromal stage of bipolar disorder and early onset schizophrenia spectrum disorders during adolescence. Psychiatry Res 275:315–325

    Article  Google Scholar 

  6. Mcgorry PD, Killackey E, Yung A (2008) Early intervention in psychosis: concepts, evidence and future directions. World Psychiatry 7:148–156. https://doi.org/10.1002/j.2051-5545.2008.tb00182.x

    Article  PubMed  PubMed Central  Google Scholar 

  7. Schmidt SJ, Schultze-Lutter F, Schimmelmann BG et al (2015) EPA guidance on the early detection in clinical high risk states of psychoses. Eur Psychiatry 30:388–404. https://doi.org/10.1016/j.eurpsy.2015.01.013

    Article  CAS  PubMed  Google Scholar 

  8. Yung AR, McGorry PD (1996) The prodromal phase of first-episode psychosis: past and current conceptualizations. Schizophr Bull 22:353–370

    Article  CAS  Google Scholar 

  9. Arango C, Díaz-Caneja CM, McGorry PD et al (2018) Preventive strategies for mental health. Lancet Psychiatry 5:591–604

    Article  Google Scholar 

  10. Bechdolf A, Ratheesh A, Wood JS et al (2012) Rationale and first results of developing at-risk (prodromal) criteria for bipolar disorder. Curr Pharm Des 18:358–375

    Article  CAS  Google Scholar 

  11. Fusar-Poli P, Salazar de Pablo G, Correll CU et al (2020) Prevention of psychosis: advances in detection, prognosis, and intervention. JAMA Psychiat 77:755. https://doi.org/10.1001/jamapsychiatry.2019.4779

    Article  Google Scholar 

  12. Millan MJ, Andrieux A, Bartzokis G et al (2016) Altering the course of schizophrenia: progress and perspectives. Nat Rev Drug Discov 15:485–515. https://doi.org/10.1038/nrd.2016.28

    Article  CAS  PubMed  Google Scholar 

  13. Catalan A, Salazar de Pablo G, Vaquerizo Serrano J et al (2020) Annual research review: prevention of psychosis in adolescents—systematic review and meta-analysis of advances in detection, prognosis and intervention. J Child Psychol Psychiatry. https://doi.org/10.1111/jcpp.13322

    Article  PubMed  Google Scholar 

  14. Fusar-Poli P, Cappucciati M, Borgwardt S et al (2016) Heterogeneity of psychosis risk within individuals at clinical high risk: a meta-analytical stratification. JAMA Psychiat 73:113. https://doi.org/10.1001/jamapsychiatry.2015.2324

    Article  Google Scholar 

  15. Salazar de Pablo G, Catalan A, Fusar-Poli P (2020) Clinical validity of DSM-5 attenuated psychosis syndrome: advances in diagnosis, prognosis, and treatment. JAMA Psychiat 77:311. https://doi.org/10.1001/jamapsychiatry.2019.3561

    Article  Google Scholar 

  16. Jacobs E, Kline E, Schiffman J (2011) Practitioner perceptions of attenuated psychosis syndrome. Schizophr Res 131:24–30. https://doi.org/10.1016/j.schres.2011.06.022

    Article  PubMed  PubMed Central  Google Scholar 

  17. Jacobs E, Kline E, Schiffman J (2012) Defining treatment as usual for attenuated psychosis syndrome: a survey of community practitioners. Psychiatr Serv 63:1252–1256. https://doi.org/10.1176/appi.ps.201200045

    Article  PubMed  PubMed Central  Google Scholar 

  18. Fusar-Poli P, Sullivan SA, Shah JL, Uhlhaas PJ (2019) Improving the detection of individuals at clinical risk for psychosis in the community, primary and secondary care: an integrated evidence-based approach. Front Psych. https://doi.org/10.3389/fpsyt.2019.00774

    Article  Google Scholar 

  19. Takahashi T, Higuchi Y, Komori Y et al (2017) Quality of life in individuals with attenuated psychotic symptoms: possible role of anxiety, depressive symptoms, and socio-cognitive impairments. Psychiatry Res 257:431–437. https://doi.org/10.1016/j.psychres.2017.08.024

    Article  PubMed  Google Scholar 

  20. Zhang T, Xu L, Tang X et al (2020) Real-world effectiveness of antipsychotic treatment in psychosis prevention in a 3-year cohort of 517 individuals at clinical high risk from the SHARP (ShangHai At Risk for Psychosis). Aust N Z J Psychiatry 54:696–706. https://doi.org/10.1177/0004867420917449

    Article  PubMed  Google Scholar 

  21. Lee EH-M, Hui CL-M, Ching EY-N et al (2016) Public stigma in China associated with schizophrenia, depression, attenuated psychosis syndrome, and psychosis-like experiences. Psychiatr Serv 67:766–770. https://doi.org/10.1176/appi.ps.201500156

    Article  PubMed  Google Scholar 

  22. Fusar-Poli P, Davies C, Solmi M et al (2019) Preventive treatments for psychosis: umbrella review (just the evidence). Front Psych 10:764

    Article  Google Scholar 

  23. Fusar-Poli P, Rutigliano G, Stahl D et al (2017) Development and validation of a clinically based risk calculator for the transdiagnostic prediction of psychosis. JAMA Psychiat 74:493–500

    Article  Google Scholar 

  24. Mcgorry PD, Hartmann JA, Spooner R, Nelson B (2018) Beyond the “at risk mental state” concept : transitioning to transdiagnostic psychiatry. World Psychiatry 17:133–142

    Article  Google Scholar 

  25. Freedman R, Lewis DA, Michels R et al (2013) The initial field trials of DSM-5: New blooms and old thorns. AJP 170:1–5. https://doi.org/10.1176/appi.ajp.2012.12091189

    Article  Google Scholar 

  26. Fusar-Poli P, Cappucciati M, Rutigliano G et al (2015) At risk or not at risk? A meta-analysis of the prognostic accuracy of psychometric interviews for psychosis prediction. World Psychiatry 14:322–332

    Article  Google Scholar 

  27. Bowie CR, McLaughlin D, Carrión RE et al (2012) Cognitive changes following antidepressant or antipsychotic treatment in adolescents at clinical risk for psychosis. Schizophr Res 137:110–117. https://doi.org/10.1016/j.schres.2012.02.008

    Article  PubMed  PubMed Central  Google Scholar 

  28. Cornblatt BA, Lencz T, Smith CW et al (2007) Can antidepressants be used to treat the schizophrenia prodrome?: Results of a prospective, naturalistic treatment study of adolescents. J Clin Psychiatry 68:546–557. https://doi.org/10.4088/JCP.v68n0410

    Article  CAS  PubMed  Google Scholar 

  29. Devoe DJ, Farris MS, Townes P, Addington J (2020) Interventions and transition in youth at risk of psychosis: a systematic review and meta-analyses. J Clin Psychiatry. https://doi.org/10.4088/JCP.17r12053

    Article  PubMed  Google Scholar 

  30. Raballo A, Poletti M, Preti A (2020) Meta-analyzing the prevalence and prognostic effect of antipsychotic exposure in clinical high-risk (CHR): when things are not what they seem. Psychol Med. https://doi.org/10.1017/S0033291720004237

    Article  PubMed  Google Scholar 

  31. Vitiello B (2008) An international perspective on pediatric psychopharmacology. Int Rev Psychiatry 20:121–126. https://doi.org/10.1080/09540260801887710

    Article  PubMed  Google Scholar 

  32. Fusar-Poli P, Werbeloff N, Rutigliano G et al (2019) Transdiagnostic risk calculator for the automatic detection of individuals at risk and the prediction of psychosis: second replication in an independent National Health Service Trust. Schizophr Bull 45:562–570. https://doi.org/10.1093/schbul/sby070

    Article  PubMed  Google Scholar 

  33. Beck A, Nadkarni A, Calam R et al (2016) Increasing access to cognitive behaviour therapy in low and middle income countries: a strategic framework. Asian J Psychiatr 22:190–195. https://doi.org/10.1016/j.ajp.2015.10.008

    Article  PubMed  Google Scholar 

  34. Pelizza L, Azzali S, Paterlini F et al (2019) The “Reggio Emilia At-Risk Mental States” program: a diffused, “liquid” model of early intervention in psychosis implemented in an Italian Department of Mental Health. Early Interv Psychiatry 13:1513–1524. https://doi.org/10.1111/eip.12851

    Article  PubMed  Google Scholar 

  35. Trask CL, Kameoka VA, Schiffman J, Cicero DC (2019) Perceptions of attenuated psychosis in a diverse sample of undergraduates. Early Interv Psychiatry 13:922–927. https://doi.org/10.1111/eip.12710

    Article  PubMed  Google Scholar 

  36. Banuri S, de Walque D, Keefer P, Haidara OD, Robyn PJ, Ye M (2018) The use of video vignettes to measure health worker knowledge. Evidence from Burkina Faso. Soc Sci Med 213:173–180. https://doi.org/10.1016/j.socscimed.2018.07.046

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This research was contemplated by the high-risk working group of the ECNP School of Child and Adolescent Neuropsychopharmacology, 2019. We are grateful for all mentors who organized the school. We thank Prof. Gil Zalsman for reviewing our vignettes and providing valuable feedback. We also thank Prof. Christoph Correll for mentoring us when planning this study.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Department of Child and Adolescent Psychiatry, Ankara City Hospital, Üniversiteler, Bilkent Blv. No: 1, Çankaya, 06800, Ankara, Turkey

    Helin Yilmaz Kafali

  2. Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK

    Mireia Solerdelcoll

  3. Department of Medicine, University of Barcelona, Barcelona, Spain

    Mireia Solerdelcoll

  4. PsychiatryDepartment of Child and Adolescent Psychiatry, University of Belgrade Faculty of Medicine, Belgrade, Serbia

    Lena Vujinovic

  5. Department of Psychiatry and Narcology, Bogomolets National Medical University, Kyiv, Ukraine

    Dmytro Martsenkovskyi

  6. Center of Medical and Psychological Rehabilitation of Children, National Children’s Specialized Hospital “OHMATDYT”, Kyiv, Ukraine

    Dmytro Martsenkovskyi

  7. Leicestershire Partnership NHS Trust, Leicester, UK

    Sewanu Awhangansi

  8. Department of Child Psychiatry, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium

    Camille Noel

  9. Child and Adolescent Psychiatry Hospital, La Petite Maison ACIS, Chastre, Belgium

    Camille Noel

  10. Department of Psychiatry, Dokuz Eylul School of Medicine, Izmir, Turkey

    Emre Bora

  11. Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, Carlton South, VIC, Australia

    Emre Bora

  12. Child and Adolescent Psychiatry Department, Institute of Psychiatry and Mental Health, CIBERSAM, School of Medicine, Hospital General Universitario Gregorio Marañón IiSGM, Universidad Complutense, Madrid, Spain

    Celso Arango

Authors
  1. Helin Yilmaz Kafali
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mireia Solerdelcoll
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lena Vujinovic
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Dmytro Martsenkovskyi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sewanu Awhangansi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Camille Noel
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Emre Bora
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Celso Arango
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Helin Yilmaz Kafali.

Ethics declarations

Conflict of interest

Dr. Solerdelcoll receives grant support from the Alicia Koplowitz Foundation. Dr Arango has been supported by the Spanish Ministry of Science and Innovation. Instituto de Salud Carlos III (SAM16PE07CP1, PI16/02012, PI19/024), co-financed by ERDF Funds from the EuropeanCommission, “A way of making Europe”, CIBERSAM. Madrid Regional Government (B2017/BMD-3740 AGES-CM-2), European Union Structural Funds. European Union Seventh Framework Program under grant agreements FP7-4-HEALTH-2009-2.2.1-2-241909 (Project EU-GEI), FP7- HEALTH-2013-2.2.1-2-603196 (Project PSYSCAN) and FP7-HEALTH-2013-2.2.1-2-602478 (Project METSY); and European Union H2020 Program under the Innovative Medicines Initiative 2 Joint Undertaking (grant agreement No 115916, Project PRISM, and grant agreement No 777394, Project AIMS-2-TRIALS), Fundación Familia Alonso and Fundación Alicia Koplowitz. The authors declare that they have no potential conflicts of interest in relation to this article.

Ethical approval

This study was approved by the clinical research ethics review committee of the Ministry of Health Ankara City Hospital from Ankara, Turkey (E1/090/2019, 24.10.2019).

Consent to participate

Only the survey administrator had access to the personally identifiable information of participants. Informed consent was acquired before each participant administered the questionnaire online.

Consent to publications

The Authors hereby consent to publication of the Work in European Child and Adolescent Psychiatry.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 18 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yilmaz Kafali, H., Solerdelcoll, M., Vujinovic, L. et al. Evaluating the tendencies of community practitioners who actively practice in child and adolescent psychiatry to diagnose and treat DSM-5 attenuated psychotic syndrome. Eur Child Adolesc Psychiatry 31, 1635–1644 (2022). https://doi.org/10.1007/s00787-021-01897-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00787-021-01897-1

Keywords

Search

Navigation