PMID- 28498576
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20201001
IS  - 1723-8617 (Print)
IS  - 2051-5545 (Electronic)
IS  - 1723-8617 (Linking)
VI  - 16
IP  - 2
DP  - 2017 Jun
TI  - A critique of the "ultra-high risk" and "transition" paradigm.
PG  - 200-206
LID - 10.1002/wps.20423 [doi]
AB  - The transdiagnostic expression of psychotic experiences in common mental disorder 
      (anxiety/depression/substance use disorder) is associated with a poorer 
      prognosis, and a small minority of people may indeed develop a clinical picture 
      that meets criteria for schizophrenia. However, it appears neither useful nor 
      valid to observe early states of multidimensional psychopathology in young people 
      through the "schizo"-prism, and apply misleadingly simple, unnecessary and 
      inefficient binary concepts of "risk" and "transition". A review of the 
      "ultra-high risk" (UHR) or "clinical high risk" (CHR) literature indicates that 
      UHR/CHR samples are highly heterogeneous and represent individuals diagnosed with 
      common mental disorder (anxiety/depression/substance use disorder) and a degree 
      of psychotic experiences. Epidemiological research has shown that psychotic 
      experiences are a (possibly non-causal) marker of the severity of 
      multidimensional psychopathology, driving poor outcome, yet notions of "risk" and 
      "transition" in UHR/CHR research are restrictively defined on the basis of 
      positive psychotic phenomena alone, ignoring how baseline differences in 
      multidimensional psychopathology may differentially impact course and outcome. 
      The concepts of "risk" and "transition" in UHR/CHR research are measured on the 
      same dimensional scale, yet are used to produce artificial diagnostic shifts. In 
      fact, "transition" in UHR/CHR research occurs mainly as a function of variable 
      sample enrichment strategies rather than the UHR/CHR "criteria" themselves. 
      Furthermore, transition rates in UHR/CHR research are inflated as they do not 
      exclude false positives associated with the natural fluctuation of dimensional 
      expression of psychosis. Biological associations with "transition" thus likely 
      represent false positive findings, as was the initial claim of strong effects of 
      omega-3 polyunsatured fatty acids in UHR samples. A large body of UHR/CHR 
      intervention research has focused on the questionable outcome of "transition", 
      which shows lack of correlation with functional outcome. It may be more 
      productive to consider the full range of person-specific psychopathology in all 
      young individuals who seek help for mental health problems, instead of "policing" 
      youngsters for the transdiagnostic dimension of psychosis. Instead of the 
      relatively inefficient medical high-risk approach, a public health perspective, 
      focusing on improved access to a low-stigma, high-hope, small scale and 
      youth-specific environment with acceptable language and interventions may 
      represent a more useful and efficient strategy.
CI  - (c) 2017 World Psychiatric Association.
FAU - van Os, Jim
AU  - van Os J
AD  - Department of Psychiatry and Psychology, Maastricht University Medical Centre, 
      Maastricht, the Netherlands.
AD  - King's College London, King's Health Partners, Department of Psychosis Studies, 
      Institute of Psychiatry, London, UK.
FAU - Guloksuz, Sinan
AU  - Guloksuz S
AD  - Department of Psychiatry and Psychology, Maastricht University Medical Centre, 
      Maastricht, the Netherlands.
AD  - Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
LA  - eng
PT  - Journal Article
PL  - Italy
TA  - World Psychiatry
JT  - World psychiatry : official journal of the World Psychiatric Association (WPA)
JID - 101189643
PMC - PMC5428198
OTO - NOTNLM
OT  - Ultra-high risk
OT  - common mental disorder
OT  - psychotic experiences
OT  - public health perspective
OT  - transdiagnostic expression of psychosis
OT  - transition
EDAT- 2017/05/13 06:00
MHDA- 2017/05/13 06:01
PMCR- 2017/06/01
CRDT- 2017/05/13 06:00
PHST- 2017/05/13 06:00 [entrez]
PHST- 2017/05/13 06:00 [pubmed]
PHST- 2017/05/13 06:01 [medline]
PHST- 2017/06/01 00:00 [pmc-release]
AID - WPS20423 [pii]
AID - 10.1002/wps.20423 [doi]
PST - ppublish
SO  - World Psychiatry. 2017 Jun;16(2):200-206. doi: 10.1002/wps.20423.