Mapping the Onset of Psychosis: The Comprehensive Assessment of At-Risk Mental States

  title={Mapping the Onset of Psychosis: The Comprehensive Assessment of At-Risk Mental States},
  author={Alison Ruth Yung and Hok Pan Yuen and Patrick D. McGorry and Lisa J. Phillips and Daniel Robert Kelly and Margaret Dell'olio and Shona M Francey and Elizabeth M. Cosgrave and E{\'o}in Killackey and Carrie Stanford and Katherine A. Godfrey and Joe A. Buckby},
  journal={Australian and New Zealand Journal of Psychiatry},
  pages={964 - 971}
Objective: Recognizing the prodrome of a first psychotic episode prospectively creates the opportunity of intervention, which could delay, ameliorate or even prevent onset. Valid criteria and a reliable methodology for identifying possible prodromes are needed. This paper describes an instrument, the Comprehensive Assessment of At-Risk Mental States (CAARMS), which has been designed for such a purpose. It has two functions: (i) to assess psychopathology thought to indicate imminent development… 

Tables from this paper

[Polish version of Comprehensive Assessment of At Risk Mental States (CAARMS)--the description of the method].
The first psychotic episode is usually preceded by the decline in functioning as well as the occurrence of symptoms, which due to low intensity or short duration do not fulfil the criteria allowing
Young people at ultra high risk for psychosis: research from the PACE clinic.
Although there is moderate evidence for the effectiveness of specific intervention strategies in this population, the most effective type and duration of intervention is yet to be determined.
Does specific psychopathology predict development of psychosis in ultra high-risk (UHR) patients?
Few individual clinical symptoms appear to be predictive of transition to a psychotic disorder in the UHR group, and Clinicians should be cautious about the use of clinical profile alone in such individuals when determining who is at highest risk.
How well does psychosis risk criteria predict the transition to psychosis? A 10-year service audit of an early psychosis service
This research comprised a ‘layered’ service audit which examined all presentations to Psychological Assessment Service (PAS) during the ten-year period ending December 2007, and examined the relative contribution of UHR to transition to psychosis.
The ‘At-Risk Mental State’ for Psychosis in Adolescents: Clinical Presentation, Transition and Remission
Overall transition rates to psychosis were low at 24 months follow-up and many participants demonstrated a significant reduction in psychotic-like symptoms, whilst the generalisation of these findings may be limited due to the small sample size and require replication in a larger sample.
First-Rank Symptoms and Premorbid Adjustment in Young Individuals at Increased Risk of Developing Psychosis
In line with the neurodevelopmental model of psychosis, individuals at CHR might be exhibiting several vulnerability traits and manifestations of abnormal developmental processes that might predict a future psychiatric disorder and/or long-term impairment.
Testing the Ultra High Risk (prodromal) criteria for the prediction of psychosis in a clinical sample of young people
Identifying children and adolescents at ultra high risk of psychosis in Italian neuropsychiatry services: a feasibility study
It is suggested that administration of the CAARMS to children and adolescents with putative prodromal psychosis is feasible and that this assessment can easily be integrated into existing Italian neuropsychiatry services although clinicians should interpret results with caution as results in this age group still have to be replicated.
Whither the attenuated psychosis syndrome?
The attenuated psychosis syndrome (APS) will not be a coded diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and was based on criteria developed in the mid-1990s that were informed by a comprehensive review of retrospective studies on the prodromal phase of nonaffective psychosis.
Validation of “prodromal” criteria to detect individuals at ultra high risk of psychosis: 2 year follow-up


Prediction of psychosis
It is demonstrated that it is possible to identify individuals with a high likelihood of onset of psychosis within a brief follow-up period, which lays the foundation for early treatment in an attempt to prevent, delay or minimise the severity of first onset of schizophrenia.
Psychosis prediction: 12-month follow up of a high-risk (“prodromal”) group
The Initial Prodrome in Psychosis: Descriptive and Qualitative Aspects
  • A. Yung, P. McGorry
  • Psychology, Medicine
    The Australian and New Zealand journal of psychiatry
  • 1996
The ground work has been laid for the development of better methodologies for assessing and measuring first psychotic prodromes with increased emphasis on experiential phenomena, which has the potential to lead to the early recognition and more accurate prediction of subsequent psychosis.
Risk factors for psychosis in an ultra high-risk group: psychopathology and clinical features
The prodromal phase of first-episode psychosis: past and current conceptualizations.
This article proposes an alternative model for conceptualizing prodromal changes (the hybrid/interactive model) and discusses the different ways to view this phase of first-episode psychosis.
Monitoring and care of young people at incipient risk of psychosis.
The theoretical background, origins, and development of a new clinical service for intervention in the putatively prodromal phase of schizophrenia and other psychotic disorders and preliminary data from the service's 20-month pilot phase are presented.
Commentary: The schizophrenia prodrome: a high-risk concept.
  • A. Yung
  • Psychology, Medicine
    Schizophrenia bulletin
  • 2003
There is now some evidence that suggests that the prevention of, or at least the ability to delay or ameliorate, the onset of a full-blown psychotic disorder is becoming possible, as is the aim of indicated prevention.
When does experience of psychosis result in a need for care? A prospective general population study.
It is suggested that qualitative differences in self-initiated coping modify the risk for need for care and subsequent patient status in those who experience psychotic symptoms and point to the possible importance of early coping-based interventions.
Prospective diagnosis of the initial prodrome for schizophrenia based on the Structured Interview for Prodromal Syndromes: preliminary evidence of interrater reliability and predictive validity.
In small groups of subjects, these diagnostic criteria for the schizophrenic prodrome and the Structured Interview for Prodromal Syndromes showed promising interrater reliability and predictive validity.
Early self‐experienced neuropsychological deficits and subsequent schizophrenic diseases: an 8‐year average follow‐up prospective study
It is suggested that certain self‐experienced neuropsychological deficits are able to indicate susceptibility to psychosis.