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Need for evidence-based early intervention programmes: a public health perspective.

Sinan Guloksuz1,2, Jim van Os1,3,4

  • 1Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands.

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|October 5, 2018
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Summary

The current ultra-high risk (UHR) or clinical high risk (CHR) framework for psychosis transition has limited public health impact due to issues with prediction and intervention effectiveness. A broader, transdiagnostic approach to early psychopathology intervention may be more beneficial.

Keywords:
adult psychiatry

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Area of Science:

  • Psychiatry
  • Public Health
  • Clinical Psychology

Background:

  • The current framework for identifying individuals at ultra-high risk (UHR) or clinical high risk (CHR) for psychosis transition is widely used.
  • However, its effectiveness in generating measurable and economically feasible public health impacts is questioned.

Purpose of the Study:

  • To critically evaluate the limitations of the UHR/CHR framework for psychosis transition.
  • To explore alternative strategies for early intervention in psychopathology.

Main Methods:

  • Review of existing literature and meta-analytical evidence on UHR/CHR predictive accuracy and intervention efficacy.
  • Analysis of the determinants of psychosis transition rates.
  • Discussion of the limitations of current assessment tools and sampling strategies.

Main Results:

  • The 'transition' rate is primarily determined by risk-enrichment, not predictive accuracy of UHR/CHR tools.
  • Prognostic accuracy of assessment tools is mediocre.
  • Therapeutic interventions may prolong, not prevent, psychosis onset.
  • No effective treatments are proven to prevent transition.
  • The UHR/CHR target is precarious due to unpredictability and false positives.
  • Only a small fraction of individuals developing psychosis benefit from UHR/CHR services.
  • Limited cost-effectiveness data exists for these services.

Conclusions:

  • The narrow focus of the UHR/CHR framework presents significant limitations for public health impact.
  • A broader, transdiagnostic prevention strategy for early psychopathology is a more promising alternative.
  • Further economic evaluations of extended, transdiagnostic early intervention programs are needed.