Transcript WELCOME Recent Advances in Psychopharmacology
How to Assess for Early Psychosis
Rachel Loewy, PhD UCSF Prodrome Assessment Research and Treatment (PART) Program
What is Early Psychosis?
• Schizophrenia as prototype (schizophrenia, schizoaffective, schizophreniform) • Can include bipolar & unipolar depression Early = A) Recent onset psychotic disorders (within 3 yrs) B) at imminent risk for onset of psychosis
What do we mean by “Prodromal?”
• Webster’s Definition : An early symptom indicating the onset of a disorder • Medical example: – Fever is prodromal to measles • Prodromal definition in relation to psychosis: “Period preceding the onset of the first florid psychotic episode, when there is increasing symptomatic presentation and functional deterioration (NIMH).” • Ultra-high-risk (UHR)
Model of Progression from Prodrome to Psychosis
1-3 yrs 3-5 yrs Childhood Adolescence Adulthood No Sx Non-specific Sx noticed by patient Sub-psychotic Sx affects functioning Psychotic level Sx Treatment success
Who is at ultra-high-risk for psychosis?
Prodromal period of thought disorders
Symptoms in this stage include: •
Specific Symptoms:
Positive Symptoms: experiences in excess of normal functioning •
Non-specific Symptoms: Negative Symptoms, Disorganization, Affective Symptoms
– – Cognitive Social – – Mood Functioning
Structured Interview for Prodromal Syndromes (SIPS)
• Research diagnostic criteria • 20% - 40% transition rate by 1 year • Structured interview with patient and parents requires 2-3 hours
UHR Conversion Rates: NAPLS study (N=291) 50% 40%
Full Psychosis
30% 20% 10% 0% 6
Cannon, et al, 2008
12 18
Months
24 30
Structured Interview for Prodromal Syndromes (SIPS)
1) Attenuated Positive Symptom Prodromal Syndrome:
• One or more subthreshold positive symptoms, not fully psychotic in intensity: Unusual thought content /delusional ideas, suspiciousness/ persecutory ideas, grandiosity, perceptual abnormalities/distortions, conceptual disorganization. • Currently present at a frequency of at least once per week, onset or worsening in the past year.
Structured Interview for Prodromal Syndromes (SIPS)
2) Brief Intermittent Psychosis Prodromal Syndrome:
• One or more fully psychotic symptoms: • Hallucinations (auditory, visual, tactile, etc.), • Delusions (thought broadcasting, thought insertion, • paranoia, grandeur, etc.) and Formal thought disorder (loosening of associations, flight of ideas, etc.) • Present intermittently for at least several minutes/day at least once per month,
but less than
1 hour/ day, 4 days/week over 1 month.
Structured Interview for Prodromal Syndromes (SIPS)
3) Genetic Risk and Deterioration Prodromal Syndrome:
• Precipitous decline in role functioning rated on the General Assessment of Functioning (GAF) scale as a drop of at least 30% in the past 12 months
AND
one of the following
:
• • Meets criteria for schizotypal personality disorder
OR
Has a family history of schizophrenia (psychotic disorder in a first-degree relative)
Unusual Thinking
•
Confusion about what is real and what is imaginary
•
Ideas of reference
•
Preoccupation with the supernatural (telepathy, ghosts, UFOs)
•
Other unusual thoughts
: Mind tricks, nihilistic ideas, somatic ideas, overvalued beliefs, delusions of control
Suspiciousness
•
Excessive suspiciousness, paranoid thinking Grandiosity
•
Unrealistic ideas of special identity or abilities
Perceptual Disturbances
• Increased sensitivity to light and sound • Hearing things that other people don’t hear • Seeing things that others don’t see • Smelling, tasting, or feeling unusual sensations that other people don’t experience
Disorganized Communication
• Difficulty getting the point across; trouble directing sentences towards a goal • Rambling, going off track during conversations • Incorrect words, irrelevant topics • Odd speech
Negative Symptoms
• Wanting to spend more time alone • Not feeling motivated to do things • Trouble understanding conversations or written materials • Difficulty identifying and expressing emotions
Disorganized Symptoms
• Neglect of personal hygiene • Odd appearance or behavior • Laughing at odd or inappropriate times • Trouble with attention, clear thinking, comprehension
Impairment in Functioning
•
Decline in functioning at school or work
•
Problems in relationships with friends or family
Structured Interview for Prodromal Syndromes (SIPS)
Positive Symptoms Scale: 0 1 2 Absent Questionable Subthreshold 3-5 Attenuated Range 6 Fully Psychotic
Structured Interview for Prodromal Syndromes (SIPS)
1. Onset
: “When did (specific symptom) start?” 2.
Duration of symptoms
: “When (specific symptom) occurs, how long does it last?” 3.
Frequency:
“How often does (specific symptom) occur?”
Structured Interview for Prodromal Syndromes (SIPS)
4.
Degree of Distress
: What is this experience like for you? (Does it bother you?) Fully Psychotic = May be afraid/worried or may not. 5.
Degree to which it interferes with life
: Do you ever act on this experience? Do you ever do anything differently because of it? Fully Psychotic = They act on their belief.
6.
Degree of Conviction/Meaning
: How do you account for this experience? Do you ever feel that it could it just be in your head? Do you think this is real?
Fully Psychotic = Not able to induce doubt.