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Early Detection

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This presentation shows the results of screening a help-seeking population for the ultrahigh risk to develop psychosis or other psychiatric disorders

This presentation shows the results of screening a help-seeking population for the ultrahigh risk to develop psychosis or other psychiatric disorders


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  • 1. The detection of Ultra High Risk patients in a help-seeking population: first data from EDIE.NL Magic tricks with epidemiology: finding the needle in the haystack May 6 th 2010 Edinburgh, Scotland Mark van der Gaag
  • 2. Acknowledgements
    • David van den Berg
    • Petra Bervoets
    • Nynke Boonstra
    • Marion Bruns
    • Sara Dragt
    • Sarah Eussen
    • Gitty de Haan
    • Mischa van der Helm
    • Martijn Huijgen
    • Helga Ising
    • Lianne Kampman
    • Rianne Klaassen
    • Don Linszen
    • Aaltsje Malda
    • Carin Meijer
    • Julia Meijer
    • Roeline Nieboer
    • Dorien Nieman
    • Bianca Raijmakers
    • Judith Rietdijk
    • Marleen Rietveld
    • Nadia van der Spek
    • Annelies van Strater
    • Tinie van de Tang
    • Zhenya Tatkova
    • Jenny van der Werf
    • Swanny Wierenga
    • Lex Wunderink
    • Annemieke Zwart
    Alison Yung Tony Morrison Paul French Lucia Valmaggia Rachel Loewy Pim Cuijpers Niels Smits Kees Korrelboom ZonMW grant
  • 3.
  • 4.
  • 5. The base rate problem General population: 17% positive on test Incidence is 2 per 10.000 each year Level 3: 20% positive on test Incidence is 10 % each year Positive predictive value = 0.06 % Positive predictive value = 25 % False positive = unnecessary treatment 14-05-2009 Test pos Test neg Psychosis 1 1 No psych 1699 8299 Test pos Test neg Psychosis 500 500 No psych 1500 7500
  • 6. Prevalence subclinical symptoms
  • 7. NEMESIS: evidence for psychologal factors in the final pathway to psychosis Outcome at 3 years follow-up N=7076: 18.1% PLEs 84% remission 8% PLE 8% PSY Negative appraisal of PLEs  psychosis Hanssen, 2005 Hallucinations + negative appraisal  psychosis Krabbendam, 2004
  • 8. Combination of axis 1 disorder plus ARMS
  • 9. Sackett, Haynes, Guyatt and Tugwell 1991
  • 10. The (presumed) natural course of dopamine-sensitisation
    • Collip e.a, 2008
  • 11. Persistence of UHR by exposure to trauma, cannabis and urbanisation Cougnard, 2007
  • 12. ARMS in secondary mental health? SZ Psychosis Level 3: PLE with distress, help-seeking, co-morbidity, decline in functioning Level 2: other psychiatric syndromes, sporadic PLE Level 1: PLE, no distress, no help-seeking, no decline in functioning Level 0: no psychotic-like experiences Yung, 2006 Wanted
  • 13. Enrichment by closing in strategy
    • Help-seeking for a co-mobid axis 1 disorder
    • Young people 14-35 years of age
    • Psychotic-like experiences (Prodromal Questionnaire)
    • Decline in functioning
  • 14. 24 Months PQ: March 1st 2010
    • 3523 PQ in Den Haag (100%)
    • 778 PQ>=18 (22.1%)
      • -31 no longer in care at secondary mental health
      • -29 outside service region
      • -25 antipsychotic medication /psychosis in past
      • -22 no competence of the Dutch language
      • -17 GAF score >65
      • 0 serious learning disabilities
      • -22 other reasons
  • 15. CAARMS results in a PQ enriched sample
    • 632 eligible to be assessed with the CAARMS (17.9%)
      • -43 refusals
      • -119 no contact possibilities
      • -50 2 times no show at appointment
    • 420 actually assessed (11.9%)
      • 52 psychosis (1.5%)
      • 154 ARMS (4.4%)
      • 214 did not meet criteria (6.1%)
  • 16.
  • 17. Comorbid disorders of UHR
  • 18. CAARMS results in a PQ enriched sample =2=
    • Informed consent 94 of 154 (2.3%) (58% of ARMS)
      • 9 Genetic group
      • 77 Sub threshold intensity
      • 7 Sub threshold frequency
      • 1 BLIPS (brief limited interval psychotic symptoms <7 days; spontaneous remission)
    • 15 Transitions into psychosis in 12 months average (0.4%) (16% van ARMS)
  • 19. Sensitivity en specificity of PQ at the gold standard CAARMS ARMS plus Psychosis
  • 20. Present work
    • Shorten PQ with the use of adaptive testing
    • Ideal outcome:
    • E.g. 5 items
    •  stop at score 0
    •  proceed with score >=1
    • Another 5 items
    •  detect cutoff with high NPV of 98% and medium PPV of 40-50%
  • 21. Conclusions
    • Enrichment of the target sample with
    • *help-seeking
    • *young people
    • *with psychotic-like symptoms
    • will result in a sample with 48 percent ARMS and psychosis
    • The needle in the haystack can be found!
  • 22. Thank you for your attention Mark van der Gaag [email_address]