The document discusses the concepts of At Risk Mental State (ARMS), Ultra High Risk (UHR), and Attenuated Psychosis Syndrome. ARMS refers to individuals at risk but not certain to develop psychosis. UHR criteria were introduced to identify those at the highest risk, defined as having attenuated psychotic symptoms, brief intermittent psychotic symptoms, or vulnerability factors plus functional impairment. Studies found 20-40% of UHR individuals developed psychosis within 1-2 years. Basic symptom criteria also predicted increased risk. While Attenuated Psychosis Syndrome was proposed for DSM-5, it was ultimately included only for further study and not as an official diagnosis.
DISORDER CONTENTOF THOUGHT -DELUSION
BY DR.WASIM
UNDER GUIDANCE OF
DR.SANJAY.JAIN
Definition of delusion:
Delusions are categorized into four different groups
THERE ARE 2 TYPES OF DISORDERS OF THOUGHT CONTENT
1.DELUSION
2.OVERVALUED IDEAS
DISTINGUISED
DELUSION
OTHER MEMBERS OF THE CULTURE DONOT SHARE THE BELIEF.
NEED NOT BE ASSOCIATED WITH AFFECT.
FIRMLY SUSTAINED BELIEF.
CONVINCED THAT DELUSION IS REAL.
RECOGNIZED AS ABSURED.
CANNOT BE ACCEPTED.
OCCUR IN MENTALLY ILL PATIENTS.
OVERVALUED IDEAS
OTHER MEMBERS OF THE CULTURE SHARE THE BELIEF.
ASSOCIATED WITH VERY STRONG AFFECT.
NOT HELD FIRMLY.
ATLEAST SOME LEVEL OF DOUBT AS TO ITS TRUTHFULNESS.
NOT RECOGNIZED AS ABSURED.
ACCEPTABLE.
CAN OCCUR IN BOTH HEALTHY AND MENTALLY ILL PATIENTS.
KENDLER’S VECTORS FOR DELUSION:
five stages in the development of delusion(FISH & CONRAD)
FACTORS CONCERNED WITH GENERATION OF DELUSIONS
PATHPOPHYSIOLOGY OF DELUSIONS
PRIMARY DELUSIONS
SECONDARY DELUSIONS
SYSTEMATIZATION
DELUSIONS ON THE BASIS OF CONTENT OF DELUSIONS
THANK YOU
Identify the distinction of DSM 5 vs ICD.
Explain the significant change in the fifth edition .
Discuss and differentiate the purposes of mental illness classification.
DISORDER CONTENTOF THOUGHT -DELUSION
BY DR.WASIM
UNDER GUIDANCE OF
DR.SANJAY.JAIN
Definition of delusion:
Delusions are categorized into four different groups
THERE ARE 2 TYPES OF DISORDERS OF THOUGHT CONTENT
1.DELUSION
2.OVERVALUED IDEAS
DISTINGUISED
DELUSION
OTHER MEMBERS OF THE CULTURE DONOT SHARE THE BELIEF.
NEED NOT BE ASSOCIATED WITH AFFECT.
FIRMLY SUSTAINED BELIEF.
CONVINCED THAT DELUSION IS REAL.
RECOGNIZED AS ABSURED.
CANNOT BE ACCEPTED.
OCCUR IN MENTALLY ILL PATIENTS.
OVERVALUED IDEAS
OTHER MEMBERS OF THE CULTURE SHARE THE BELIEF.
ASSOCIATED WITH VERY STRONG AFFECT.
NOT HELD FIRMLY.
ATLEAST SOME LEVEL OF DOUBT AS TO ITS TRUTHFULNESS.
NOT RECOGNIZED AS ABSURED.
ACCEPTABLE.
CAN OCCUR IN BOTH HEALTHY AND MENTALLY ILL PATIENTS.
KENDLER’S VECTORS FOR DELUSION:
five stages in the development of delusion(FISH & CONRAD)
FACTORS CONCERNED WITH GENERATION OF DELUSIONS
PATHPOPHYSIOLOGY OF DELUSIONS
PRIMARY DELUSIONS
SECONDARY DELUSIONS
SYSTEMATIZATION
DELUSIONS ON THE BASIS OF CONTENT OF DELUSIONS
THANK YOU
Identify the distinction of DSM 5 vs ICD.
Explain the significant change in the fifth edition .
Discuss and differentiate the purposes of mental illness classification.
Schizophrenia is a mental disorder that usually appears in late adolescence or early adulthood. Characterized by delusions, hallucinations, and other cognitive difficulties, schizophrenia can often be a lifelong struggle. In this article, we will cover the causes, symptoms, and treatment of schizophrenia
Schizophrenia is a mental disorder that usually appears in late adolescence or early adulthood. Characterized by delusions, hallucinations, and other cognitive difficulties, schizophrenia can often be a lifelong struggle. In this article, we will cover the causes, symptoms, and treatment of schizophrenia
This is a presentation done on 4/6/11 for the Grand Rounds at Wayne State university by Pallav Pareek M.D.
This presentation talks about the concept of prdrome as it is(if?) applicable to schizophrenia, and if schizophrenia is becoming more of a preventable illness as science progresses. If so what are the various ways and means in which we can accomplish this prevention.
Amidst so much controversy on the issue , whether there is a prodrome for this illness or not, here I have tried to present the recent advances in this field and the recent scientific literature in this regard.
Understanding Psychosis and Schizophrenia Royal EdinburghJames Coyne
Offers evidence that group of UK clinical psychologists offer misinformation to persons seeking information about services for serious mental problems.
Neil Thompson - Value Inspired Testing: Renovating Risk-Based Testing and Inn...TEST Huddle
EuroSTAR Software Testing Conference 2012 presentation on Value Inspired Testing: Renovating Risk-Based Testing and Innovating with Emergence by Neil Thompson.
See more at: http://conference.eurostarsoftwaretesting.com/past-presentations/
In the 1980, to reduce the heterogeneity of schizophrenia, researchers tried to identify homogeneous subtypes in the hope to facilitate the identification of links between symptoms and The division of symptoms as positive or negative and categorization of schizophrenia as positive and negative subtypes became popular. However, researchers noticed that negative symptoms were not inherent to the disorder alone, but may also be due to neuroleptic medications, depression and environmental factors. This was shared by the concept of primary and secondary negative symptoms. To better understand primary negative symptoms, a separate subtype of schizophrenia, deficit and non-deficit schizophrenia was given by Carpenter.According to Carpenter et al. the term ‘deficit symptoms’ should be used to refer specifically to those negative symptoms that are present as enduring traits.
These deficit symptoms occur regardless of the patient's medication status and are not specifically responsive to anticholinergic drugs or antipsychotic drug withdrawal. It was further conceptualized that the presence of poor premorbid adjustment preceding initial psychotic episode may be manifestations of the deficit syndrome. In 2001, a review of the literature suggested that deficit schizophrenia is a disease separate from other, nondeficit forms of schizophrenia .
The proposal of a separate disease was based on the evidence that deficit and nondeficit schizophrenia differ on five dimensions typically used to distinguish diseases: signs and symptoms, course of illness, pathophysiological correlates, risk and etiological factors, and treatment response.Family history
Kirkpatrick et al reviewed studies showing that the deficit/nondeficit categorization has a significant concordance within families and that family members of deficit probands, compared with relatives of nondeficit probands, have more severe social withdrawal and an increased risk of schizophrenia.
Genetics
A few studies have examined the genetics of deficit and nondeficit schizophrenia, but the results have been disappointing.
Hong et al (6) reported that the dihydropyrimidinase-related protein 2 (DRP-2) gene was associated with risk for both deficit and nondeficit schizophrenia; however, after correcting for multiple comparisons, the association with nondeficit schizophrenia was not significant, and for deficit schizophrenia the association was present only for Caucasian but not African-American Deficit patients have a more severe course of illness than nondeficit patients, with a higher prevalence of abnormal involuntary movements before administration of antipsychotic drugs and poorer social function before the onset of psychotic symptoms.
The prevalence of deficit schizophrenia has been reported to be about 15% among patients with first-episode schizophrenia and 25%–30% among those with chronic schizophrenia
The risk factor of deficit patients differ from those of nondeficit patients. Deficit patients may a
Breakout 3.4 Asthma and psychological problems - Mike ThomasNHS Improvement
Breakout 3.4 Asthma and psychological problems - Mike Thomas
Professor of Primary Care Research, University of Southampton
Chief Medical Advisor, Asthma UK
Part of a set of presentations from NHS Improvement event: Better value, better outcomes held on Thursday 21 February 2013,
Guoman Tower Hotel, London
How to deliver quality and value in chronic care:sharing the learning from the respiratory programme
ABSTRACT- Background: The occurrence of psychiatric disorders is more in the prisoners than in general population. Co-morbidity is seen to be an important and complex entity in clinical assessment of mental state competence (diminished mental capacity, temporary insanity and insanity) in the offenders at the time of the offence. It has a great role in determining all possible options in future treatment of violent offenders. Aim: This research article is focused on the co-morbid psychiatric diagnoses and the treatment outcomes in the mentally ill prisoners referred to the tertiary care mental health facility. Materials and Method: Total 100 mentally ill prisoners referred to the tertiary care psychiatric hospital during the study period (Jan 2015 - Dec 2015) was the sample size. It was a prospective study and the sampling method was of the purposive type. Results: Besides their primary diagnosis, the referred prisoners had more than one co-morbid psychiatric diagnosis in 46% of the cases. The most frequent co-occurring conditions were learning disabilities, personality disorders, and substance use disorders. The outcomes for the psychiatric conditions were positive as patients responded well to the line of management. Conclusion: The study provides valuable data to understand the mental health needs and the treatment gaps in this population so as to plan adequate services to tackle these issues. Key-words- Mentally ill prisoners, Psychiatric co-morbidities, Treatment outcomes, Substance use disorders, Personality disorders
Diagnosis and Treatment of Psychosomatic Disorder (Educational Slides)Andri Andri
This is a standard presentation for teaching medical students and colleagues about psychosomatic disorder, its diagnosis and therapy. We hope by reading this slides, you will understand the nature of psychosomatic disorder and its current approach in therapy
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
NVBDCP.pptx Nation vector borne disease control program
Attenuated psychosis syndrome, at risk mental state and ultra high risk
1. AT RISK MENTAL STATE (ARMS),
ULTRA HIGH RISK (UHR) AND
ATTENUATED PSYCHOSIS SYNDROME
- Dr.SRIRAM.R
2. What is ARMS?
• Refer to these individuals who appear to be at risk of psychosis but
in whom psychosis is not inevitable. (McGorry and Singh, 1995)
• Not all people with operationally defined subthreshold forms of
psychosis will go on to develop a diagnosable psychotic disorder
such as schizophrenia.
• The ‘‘natural history’’ of the ARMS criteria was examined. A
transition rate of 41% was demonstrated. (Yung et al., 2003)
• Factors that predict an increased likelihood of the development of
psychosis are –
▫ Long duration of subthreshold (‘prodromal’) symptoms
▫ Poor functioning at presentation
▫ High levels of depressive symptoms
▫ Higher attenuated symptoms (c/f attenuated syndrome)
3. ARMS and “Prodrome”
• Prodromal means all the people who have it, WILL develop
psychosis (100% certainty).
• Prodrome of schizophrenia has initially been defined as “an
early or premonitory manifestation of impending disease, before
specific symptoms begin”
• So prodrome is a retrospective concept rather than a prospective
concept.
• If it is not clear 100% at the time of their presentation whether
psychosis will follow or not, then “ARMS” should be used.
• So ARMS is a prospective concept introduced for early identification
of psychotic patients.
• People with ARMS are whom intervention at an early stage, before
onset of frank psychosis, could be justified in order to prevent
further deterioration and suffering.
4. Why is ARMS/Prodrome important?
• Can lead to severe functional impairment, stigmatizing
disabilities and life-threathening consequences.
• Persistence of those disabilities prior to the onset of full positive
psychotic syndrome may lower the possibility of eventual
recovery (Schultze-Lutter et al. 2008, Marshall et al. 2005,
Perkins et al. 2005, Fusar-Poli et al. 2009)
• Preventive treatment could minimize alterations in brain structure,
as well as neurobiological changes, which could lead to substantial
improvement of the prognosis (Nelson et al. 2008)
5. Clinical Criteria
for Detection of Patients at High Risk
for psychosis
1. UHR criteria (Personal assessment and crisis
evaluation clinic, Melbourne)
2. Basic symptoms criteria
7. ULTRA HIGH RISK (UHR)
Because of the non-specific nature of the ARMS as
well as absence of the “Prospective” definition of
prodrome (Yung et al., 1996), the concept of
“Ultra high risk” for psychosis was introduced by
researchers in Melbourne, Victoria in 2003,
which has subsequently undergone many
changes, and further studies, the recent one
being in early 2014.
This concept of “Ultra High Risk” is a
refined extension of ARMS
9. • Subjects were recruited into this study from the
Personal Assessment and Crisis Evaluation
(PACE) Clinic, Melbourne, Australia (Yung et al.,
1995, 1996).
• All referrals to the Clinic between March 1995
and January 1999 were screened for inclusion.
• Referral sources included general practitioners,
psychiatric services, school and university
counseling services, and other support agencies
working with young people, such as drug and
alcohol services.
10. Subjects were included in the research program if
they
(a) were aged between 14 and 30 years
(b)Met criteria for one or more of the groups
outlined
(c) had not experienced a previous psychotic
episode
(d)were living in the Melbourne metropolitan area
Exclusion criteria were: intellectual disability, lack
of fluency in English, and presence of known
organic brain disorder or previous psychosis
11. Essentially there are three sets of separate intake
criteria FOR UHR people :
Group 1: Attenuated psychotic symptoms (APS)
Group 2: ‘‘Brief Limited Intermittent Psychotic
Symptoms’’(‘‘BLIPS’’)
Group 3: Trait and State risk factors
12. Scales used in this study -
• Brief Psychiatric Rating Scale 24 item version
(BPRS) (McGorry et al., 1988)
and
• the Comprehensive Assessment of Symptoms
and History (CASH) (Andreasen, 1987) which
were used to measure the intensity of a psychotic
symptom
23. Group 1 - Attenuated Psychotic Symptoms
• Symptoms that deviate from normal phenomena but which are not yet
frankly psychotic eg. Overvalued idea.
• The duration of attenuated psychotic symptoms should be <5 years.
• This limit on the duration of the attenuated psychotic features was
included as long duration trait phenomena (schizotypal personality
disorder) rather than acute mental state change.
• However, subjects meeting this criterion might well have other
symptoms, such as depressed mood or anxiety, lasting over 5 years.
• Thus the maximum duration of symptoms applies only to the actual
psychotic-like phenomena.
24.
25. Group 2: ‘‘Brief Limited Intermittent Psychotic
Symptoms (BLIPS)’’
• Symptoms of psychotic intensity but which have a total
duration of <7 days before resolving spontaneously.
• A recency criterion is included for this group: symptoms
must have occurred within the last year.
• Someone with a brief psychotic experience which
occurred over 1 year ago would be excluded from
the study as the period of risk is thought to be no longer
current.
26.
27. Group 3 ‘‘Trait and State Risk Factors’’
• Have nonspecific symptoms such as
lowered mood or anxiety
plus
some trait risk factor for psychotic disorder (schizotypal PD) or a family
history of a psychotic disorder in a first-degree relative
at least 1 month to not longer than 5 years (to exclude trait
phenomena)
• Have marked disability or decrease in functioning.
• This severity criterion is necessary to exclude otherwise normal relatives
of patients with psychotic illnesses who have a brief period of mild
symptoms.
• A recency criterion of deterioration within the last year is also included
so that people who deteriorate but who then recover are not labeled as high
risk as the period of risk is thought to be no longer current.
28.
29. When does subject become psychotic?
• If it is a delusion, it is acquisition of delusional conviction and
preoccupation with the belief.
• Essentially the definition of psychosis describes a clinical picture of
frank delusions, hallucinations, or formal thought disorder present
most of the time and for at least one week (Exclusion criteria in
this study)
• NOTE – This definition used here is for antipsychotic rx
rather than a diagnostic category as endpoint, and does
not conform to DSM-IV standards
30.
31. RESULTS?
• Thirty-six subjects (34.6%) developed frank
psychotic symptoms within 12 months.
• Measures of symptom duration, functioning,
disability and psychopathology were made at
intake, 6 and 12 months.
• Poor functioning, long duration of symptoms,
high levels of depression and reduced attention
were all predictors of psychosis
33. RESULTS of 2006 study
• UHR+ individuals were significantly more likely
to become psychotic than UHR- individuals
(Odds Ratio 19.3, 95% CI 2.5, 150.5).
• Low functioning at baseline was associated with
psychosis onset in the whole sample and in the
UHR group.
34. A.R. Yung et al. / Schizophrenia Research 84 (2006) 57–66
35. RECENT STUDIES in UHR criteria
• More recent studies (Yung et al. 2007, McGorry et al. 2008,
Cannon et al. 2007) tends to show a lower rate of annual transition
(20-35%), which could be due to earlier detection, improved
efficacy of intervention and a “dilution effect” (greater portion of
population included)
• 30-35 % risk of psychosis within 1 to 2 years of follow-up among
UHR cases, a rate definitively higher that the incidence rate of
psychosis in the general young population (Cannon et al. 2007)
• A large longitudinal North American study published in 2009
shows that 40% of the 377 patients assessed by the Structured
Interview for Prodromal Syndromes (SIPS) as meeting criteria for
prodromal syndromes, converted to fully psychotic illness during
the 2.5 years of follow-up (Woods et al. 2009)
38. • The annual conversion rate for sample meeting basic symptoms
criteria is around 25% (Koch et al. 2010)
• Rate of conversion reaches 70% in a study with a 110 patient’s
follow-up of 9.6 years, with a mean time to onset of 5.6 years
(Nelson et al. 2008)
• Some authors consider that the Basic (Cognitive) Symptoms
precede the onset of APS and BLIPS according to according to
Comprehensive Assessment of At Risk Mental States (CAARMS)
criteria (Koutsouleris et al. 2009)
• A 2010 German retrospective study exploring the time-related
syndromic sequence preceding the onset of full-blown psychosis
(Shultze-Lutter et al. 2010) DID NOT CONFIRM ABOVE
FINDING.
40. • In a naturalistic 48-month follow-up study, the conversion rate to
first-episode psychosis was studied in 246 outpatients of an early
detection of psychosis service (FETZ); thereby, the association
between conversion, and the combined and singular use of UHR
criteria and COGDIS was compared.
• Patients that met UHR criteria and COGDIS (n = 127) at baseline
had a significantly higher risk of conversion (hr = 0.66 at month
48) and a shorter time to conversion than patients that met only
UHR criteria (n = 37; hr = 0.28) or only COGDIS (n = 30; hr = 0.23)
44. Where is it actually in DSM-5?
• At first glance, it seems to be included in “Conditions for further
study” in Page 783.
• Is it there in the main text? YES. It is given as an example 3 in
Other Specified Schizophrenia Spectrum and Other
Psychotic disorder 298.8 (F28 in ICD-10 as Other nonorganic
psychotic disorder) in Page 122.
• As an “Other” disorder with its own numerical code, APS can now
be diagnosed and used to bill for insurance reimbursement,
although the DSM-5 Psychosis task group initially promised it
would not include it.
• So technically, ATTENUATED PSYCHOSIS SYNDROME is very
much an already existing diagnosis.
45. Why should it not have been included in
DSM-5?
• Many attenuated symptoms are quite stable and do not lead to more
severe illness, as in individuals who have schizotypal personality
disorder, who rarely become psychotic, or in the nearly 10% of
normal individuals who believe in sorcery or aliens or hear voices.
• No proven treatment for this syndrome. Attempts to institute early
antipsychotic treatment have shown no long-lasting effect and only
exposed these individuals to drug side effects.
• Research also requires a consensus among researchers and funding
agencies that a population of affected persons can be identified.
46. Contd.
• Premature diagnosis may have negative consequences on the
expectations and acceptance of others in the individual’s social
environment (People diagnosed are young).
• Field testing will assess whether the diagnosis can be made reliably
over time by different clinicians on the same patient and in
agreement with those who have conducted the initial research.
• ULTIMATELY, WHY IT should not have been INCLUDED IS
BECAUSE OF INSUFFICIENT FIELD TESTING AS WELL AS
INCONCLUSIVE TREATMENT PLANS AND/OR
INAPPROPRIATE TREATMENT.
47. TREATMENTS?
• Diminution of the transition rate about 15% in favor of the
antipsychotics which reached statistical significance only in
the studies using risperidone and amisulpride (McGorry et al.
2002, Rurhmann et al. 2007).
• A randomized, placebo-controlled trial (Amminger et al. 2010)
involving long chain omega-3 FA with a 12-week intervention
and 40-weeks monitoring period showed a reduction of 22.6% (28%
to 5%) of the cumulative risk of progression to full-threshold
psychosis for the intervention group.
• Long-chain Ω-3 fatty acids also significantly reduced positive,
negative and general symptoms and improved functioning,
compared with placebo.
48. • A randomized study (Morrison et al. 2004) comparing CBT
over 6 months with monthly monitoring in 58 patients meeting
UHR criteria showed a 15% reduction of the rate of conversion
to full blown psychosis.
• Seventy-nine patients were randomized to Integrated model
treatment (Modified Assertive Community Treatment, Social
skills training, and Psycho-education in multiple-family groups). At
two-year follow-up, the proportion diagnosed with a psychotic
disorder was 25.0% for patients randomized to integrated
treatment vs standard treatment (48.3%) (Nordentoft et al. 2006).