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

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Early Detection

  1. 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. 2. Acknowledgements <ul><li>David van den Berg </li></ul><ul><li>Petra Bervoets </li></ul><ul><li>Nynke Boonstra </li></ul><ul><li>Marion Bruns </li></ul><ul><li>Sara Dragt </li></ul><ul><li>Sarah Eussen </li></ul><ul><li>Gitty de Haan </li></ul><ul><li>Mischa van der Helm </li></ul><ul><li>Martijn Huijgen </li></ul><ul><li>Helga Ising </li></ul><ul><li>Lianne Kampman </li></ul><ul><li>Rianne Klaassen </li></ul><ul><li>Don Linszen </li></ul><ul><li>Aaltsje Malda </li></ul><ul><li>Carin Meijer </li></ul><ul><li>Julia Meijer </li></ul><ul><li>Roeline Nieboer </li></ul><ul><li>Dorien Nieman </li></ul><ul><li>Bianca Raijmakers </li></ul><ul><li>Judith Rietdijk </li></ul><ul><li>Marleen Rietveld </li></ul><ul><li>Nadia van der Spek </li></ul><ul><li>Annelies van Strater </li></ul><ul><li>Tinie van de Tang </li></ul><ul><li>Zhenya Tatkova </li></ul><ul><li>Jenny van der Werf </li></ul><ul><li>Swanny Wierenga </li></ul><ul><li>Lex Wunderink </li></ul><ul><li>Annemieke Zwart </li></ul>Alison Yung Tony Morrison Paul French Lucia Valmaggia Rachel Loewy Pim Cuijpers Niels Smits Kees Korrelboom ZonMW grant
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  5. 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. 6. Prevalence subclinical symptoms
  7. 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. 8. Combination of axis 1 disorder plus ARMS
  9. 9. Sackett, Haynes, Guyatt and Tugwell 1991
  10. 10. The (presumed) natural course of dopamine-sensitisation <ul><li>Collip e.a, 2008 </li></ul>
  11. 11. Persistence of UHR by exposure to trauma, cannabis and urbanisation Cougnard, 2007
  12. 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. 13. Enrichment by closing in strategy <ul><li>Help-seeking for a co-mobid axis 1 disorder </li></ul><ul><li>Young people 14-35 years of age </li></ul><ul><li>Psychotic-like experiences (Prodromal Questionnaire) </li></ul><ul><li>Decline in functioning </li></ul>
  14. 14. 24 Months PQ: March 1st 2010 <ul><li>3523 PQ in Den Haag (100%) </li></ul><ul><li>778 PQ>=18 (22.1%) </li></ul><ul><ul><li>-31 no longer in care at secondary mental health </li></ul></ul><ul><ul><li>-29 outside service region </li></ul></ul><ul><ul><li>-25 antipsychotic medication /psychosis in past </li></ul></ul><ul><ul><li>-22 no competence of the Dutch language </li></ul></ul><ul><ul><li>-17 GAF score >65 </li></ul></ul><ul><ul><li>0 serious learning disabilities </li></ul></ul><ul><ul><li>-22 other reasons </li></ul></ul>
  15. 15. CAARMS results in a PQ enriched sample <ul><li>632 eligible to be assessed with the CAARMS (17.9%) </li></ul><ul><ul><li>-43 refusals </li></ul></ul><ul><ul><li>-119 no contact possibilities </li></ul></ul><ul><ul><li>-50 2 times no show at appointment </li></ul></ul><ul><li>420 actually assessed (11.9%) </li></ul><ul><ul><li>52 psychosis (1.5%) </li></ul></ul><ul><ul><li>154 ARMS (4.4%) </li></ul></ul><ul><ul><li>214 did not meet criteria (6.1%) </li></ul></ul>
  16. 16.
  17. 17. Comorbid disorders of UHR
  18. 18. CAARMS results in a PQ enriched sample =2= <ul><li>Informed consent 94 of 154 (2.3%) (58% of ARMS) </li></ul><ul><ul><li>9 Genetic group </li></ul></ul><ul><ul><li>77 Sub threshold intensity </li></ul></ul><ul><ul><li>7 Sub threshold frequency </li></ul></ul><ul><ul><li>1 BLIPS (brief limited interval psychotic symptoms <7 days; spontaneous remission) </li></ul></ul><ul><li>15 Transitions into psychosis in 12 months average (0.4%) (16% van ARMS) </li></ul>
  19. 19. Sensitivity en specificity of PQ at the gold standard CAARMS ARMS plus Psychosis
  20. 20. Present work <ul><li>Shorten PQ with the use of adaptive testing </li></ul><ul><li>Ideal outcome: </li></ul><ul><li>E.g. 5 items </li></ul><ul><li> stop at score 0 </li></ul><ul><li> proceed with score >=1 </li></ul><ul><li>Another 5 items </li></ul><ul><li> detect cutoff with high NPV of 98% and medium PPV of 40-50% </li></ul>
  21. 21. Conclusions <ul><li>Enrichment of the target sample with </li></ul><ul><li>*help-seeking </li></ul><ul><li>*young people </li></ul><ul><li>*with psychotic-like symptoms </li></ul><ul><li>will result in a sample with 48 percent ARMS and psychosis </li></ul><ul><li>The needle in the haystack can be found! </li></ul>
  22. 22. Thank you for your attention Mark van der Gaag [email_address]

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