Clinical presentation and need for treatment of a cohort of subjects accessing to a mental illness prevention service

https://doi.org/10.4081/ripppo.2020.434

Authors

  • Marco Solmi | marco.solmi@unipd.it Neurosciences Department, University of Padua; Neuroscience Center, University of Padua; Padua University Hospital, Psychiatry Unit, Padua, United Kingdom.
  • Mara Campeol Neurosciences Department, University of Padua; Padua University Hospital, Psychiatry Unit, Padua, Italy.
  • Federica Gentili Padua University Hospital, Psychiatry Unit, Padua, Italy.
  • Angela Favaro Neurosciences Department, University of Padua; Neuroscience Center, University of Padua; Padua University Hospital, Psychiatry Unit, Padua, Italy.
  • Carla Cremonese Padua University Hospital, Psychiatry Unit, Padua, Italy.

Abstract

Outreaching activities decrease prognostic accuracy of at-risk mental state defining tools, over-attracting subjects who are not at increased risk of mental illness. The setting was a mental illness primary indicated prevention outpatients service embedded within the Psychiatry Unit of Padua University Hospital, Italy. Help-seeking patients accessing the service between January 2018 and December 2018 were evaluated with validated tools assessing functioning, at-risk mental state, schizotypal personality features, depressive and anxious symptoms, together with medical and family history collection. The primary outcome was the prevalence of drop in functioning at presentation according to the Social and Occupational Functioning Assessment Scale (SOFAS). Secondary outcomes were diagnoses according to DSM-5 criteria and meeting criteria for at-risk mental state. Fifty-nine patients accessed the service, mean age was 18.8 (2.12) years old, 54.2% were females. Virtually all subjects (97.7%) had a drop in functioning. Baseline primary diagnoses were depressive episode in 33%, anxiety disorder in 21%, personality disorder in 17%, adjustment disorder 9%, conduct disorder 7%, schizophrenia spectrum disorder 5%, bipolar disorder 5%, eating disorder in 1.7%, dissociative disorder 1.7%. Overall, 59.1% met at-risk mental state criteria. Lower functioning was associated with anxious symptoms (p=0.031), a family history of mental illness (p=0.045) and of suicide (p=0.042), and schizotypal personality traits (p=0.036). Subjects accessing a prevention service embedded within the mental health department already present a trans-diagnostic drop in functioning, mainly due to a non-psychotic mental disorder, with at-risk mental state in one patient out of two, and schizophrenia or bipolar disorder already present in only 10% of subjects. Prevention service within mental health facility setting appears to properly detect subjects in need of treatment with a drop in functioning, at risk of developing severe mental illness, without any outreaching activity in the general population.

Dimensions

Altmetric

PlumX Metrics

Downloads

Download data is not yet available.

References

Birrell L, Newton NC, Teesson M, Tonks Z, Slade T. Anxiety disorders and first alcohol use in the general population. Findings from a nationally representative sample. J Anxiety Disord. 2015;31:108-113. doi:10.1016/j.janxdis.2015.02.008 DOI: https://doi.org/10.1016/j.janxdis.2015.02.008

Thorup A, Petersen L, Jeppesen P, et al. Gender differences in young adults with first-episode schizophrenia spectrum disorders at baseline in the Danish OPUS study. J Nerv Ment Dis. 2007;195(5):396-405. doi:10.1097/01.nmd.0000253784.59708.dd DOI: https://doi.org/10.1097/01.nmd.0000253784.59708.dd

Goodwin RD, Hamilton SP. The early-onset fearful panic attack as a predictor of severe psychopathology. Psychiatry Res. 2002;109(1):71-79. doi:10.1016/S0165-1781(01)00357-2 DOI: https://doi.org/10.1016/S0165-1781(01)00357-2

Hudson JI, Hiripi E, Pope HG, Kessler RC. The Prevalence and Correlates of Eating Disorders in the National Comorbidity Survey Replication. Biol Psychiatry. 2007;61(3):348-358. doi:10.1016/j.biopsych.2006.03.040 DOI: https://doi.org/10.1016/j.biopsych.2006.03.040

Atladottir HO, Gyllenberg D, Langridge A, et al. The increasing prevalence of reported diagnoses of childhood psychiatric disorders: a descriptive multinational comparison. Eur Child Adolesc Psychiatry. 2014;24(2):173-183. doi:10.1007/s00787-014-0553-8 DOI: https://doi.org/10.1007/s00787-014-0553-8

Penttilä M, Jaä̈skel̈ainen E, Hirvonen N, Isohanni M, Miettunen J. Duration of untreated psychosis as predictor of long-term outcome in schizophrenia: Systematic review and meta-analysis. Br J Psychiatry. 2014;205(2):88-94. doi:10.1192/bjp.bp.113.127753 DOI: https://doi.org/10.1192/bjp.bp.113.127753

Ghio L, Gotelli S, Marcenaro M, Amore M, Natta W. Duration of untreated illness and outcomes in unipolar depression: a systematic review and meta-analysis. J Affect Disord. 2014;152-154:45-51. doi:10.1016/j.jad.2013.10.002 DOI: https://doi.org/10.1016/j.jad.2013.10.002

Compton MT, Gordon TL, Goulding SM, et al. Patient-Level Predictors and Clinical Correlates of Duration of Untreated Psychosis among Hospitalized First-Episode Patients. J Clin Psychiatry. 2011;72(2):225-232. doi:10.4088/JCP.09m05704yel DOI: https://doi.org/10.4088/JCP.09m05704yel

Compton MT, Gordon TL, Weiss PS, Walker EF. The “doses” of initial, untreated hallucinations and delusions: A proof-of-concept study of enhanced predictors of first-episode symptomatology and functioning relative to duration of untreated psychosis. J Clin Psychiatry. 2011;72(11):1487-1493. doi:10.4088/JCP.09m05841yel DOI: https://doi.org/10.4088/JCP.09m05841yel

Hung CI, Liu CY, Yang CH. Untreated duration predicted the severity of depression at the two-year follow-up point. PLoS One. 2017;12(9). doi:10.1371/journal.pone.0185119 DOI: https://doi.org/10.1371/journal.pone.0185119

Medeiros GC, Senço SB, Lafer B, Almeida KM. Association between duration of untreated bipolar disorder and clinical outcome: Data from a Brazilian sample. Rev Bras Psiquiatr. 2016;38(1):6-10. doi:10.1590/1516-4446-2015-1680 DOI: https://doi.org/10.1590/1516-4446-2015-1680

Parellada M. Why psychogeriatrics starts right after adolescence. Eur Child Adolesc Psychiatry. 2013;22(7):391-393. doi:10.1007/s00787-013-0434-6 DOI: https://doi.org/10.1007/s00787-013-0434-6

Fusar-Poli P, Estradé A, Spencer TJ, et al. Pan-London Network for Psychosis-Prevention (PNP). Front psychiatry. 2019;10:707. doi:10.3389/fpsyt.2019.00707 DOI: https://doi.org/10.3389/fpsyt.2019.00707

McGorry PD, Hartmann JA, Spooner R, Nelson B. Beyond the "at risk mental state" concept: transitioning to transdiagnostic psychiatry. World Psychiatry. 2018;17(2):133-142. doi:10.1002/wps.20514 DOI: https://doi.org/10.1002/wps.20514

Fusar-Poli P, Palombini E, Davies C, et al. Why transition risk to psychosis is not declining at the OASIS ultra high risk service: The hidden role of stable pretest risk enrichment. Schizophr Res. 2018;192:385-390. doi:10.1016/j.schres.2017.06.015 DOI: https://doi.org/10.1016/j.schres.2017.06.015

Fusar-Poli P, Davies C, Rutigliano G, Stahl D, Bonoldi I, McGuire P. Transdiagnostic individualized clinically based risk calculator for the detection of individuals at risk and the prediction of psychosis: Model refinement including nonlinear effects of age. Front Psychiatry. 2019;10(MAY). doi:10.3389/fpsyt.2019.00313 DOI: https://doi.org/10.3389/fpsyt.2019.00313

Fusar-Poli P, Oliver D, Spada G, et al. Real world implementation of a transdiagnostic risk calculator for the automatic detection of individuals at risk of psychosis in clinical routine: Study protocol. Front Psychiatry. 2019;10(MAR). doi:10.3389/fpsyt.2019.00109 DOI: https://doi.org/10.3389/fpsyt.2019.00109

van Os J, Guloksuz S. A critique of the “ultra-high risk” and “transition” paradigm. World Psychiatry. 2017;16(2):200-206. doi:10.1002/wps.20423 DOI: https://doi.org/10.1002/wps.20423

Fusar-Poli P, Schultze-Lutter F, Cappucciati M, et al. The dark side of the moon: meta-analytical impact of recruitment strategies on risk enrichment in the clinical high risk state for psychosis. Schizophr Bull. 2016;42(3):732-743. doi:10.1093/schbul/sbv162

Yung AR, Yung AR, Pan Yuen H, et al. Mapping the Onset of Psychosis: The Comprehensive Assessment of At-Risk Mental States. Aust New Zeal J Psychiatry. 2005;39(11-12):964-971. doi:10.1080/j.1440-1614.2005.01714.x DOI: https://doi.org/10.1080/j.1440-1614.2005.01714.x

Goldman HH, Skodol AE, Lave TR. Revising axis V for DSM-IV: A review of measures of social functioning. Am J Psychiatry. 1992;149(9):1148-1156. doi:10.1176/ajp.149.9.1148 DOI: https://doi.org/10.1176/ajp.149.9.1148

Pirkis JE, Burgess PM, Kirk PK, Dodson S, Coombs TJ, Williamson MK. A review of the psychometric properties of the Health of the Nation Outcome Scales (HoNOS) family of measures. Health Qual Life Outcomes. 2005;3. doi:10.1186/1477-7525-3-76 DOI: https://doi.org/10.1186/1477-7525-3-76

Gowers SG, Harrington RC, Whitton A, et al. Brief scale for measuring the outcomes of emotional and behavioural disorders in children. Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA). Br J Psychiatry. 1999;174(MAY):413-416. doi:10.1192/bjp.174.5.413 DOI: https://doi.org/10.1192/bjp.174.5.413

Wing JK, Beevor AS, Curtis RH, Park SBG, Hadden S, Burns A. Health of the nation outcome scales (HoNOS): Research and development. Br J Psychiatry. 1998;172(JAN.):11-18. doi:10.1192/bjp.172.1.11 DOI: https://doi.org/10.1192/bjp.172.1.11

Fonseca-Pedrero E, Lemos-Giráldez S, Paino M, Sierra-Baigrie S, Muñiz J. Relationship between Schizotypal and Borderline Traits in College Students. Span J Psychol. 2012;15(1):306-314. doi:10.5209/rev_sjop.2012.v15.n1.37337 DOI: https://doi.org/10.5209/rev_SJOP.2012.v15.n1.37337

Fonseca-Pedrero E, Paíno-Piñeiro M, Lemos-Giráldez S, Villazón-García Ú, Muñiz J. Validation of the Schizotypal Personality Questionnaire-Brief Form in adolescents. Schizophr Res. 2009;111(1-3):53-60. doi:10.1016/j.schres.2009.03.006 DOI: https://doi.org/10.1016/j.schres.2009.03.006

HAMILTON M. A rating scale for depression. J Neurol Neurosurg Psychiatry. 1960;23:56-62. doi:10.1136/jnnp.23.1.56 DOI: https://doi.org/10.1136/jnnp.23.1.56

HAMILTON M. THE ASSESSMENT OF ANXIETY STATES BY RATING. Br J Med Psychol. 1959;32(1):50-55. doi:10.1111/j.2044-8341.1959.tb00467.x DOI: https://doi.org/10.1111/j.2044-8341.1959.tb00467.x

Hung C, Yu NW, Liu CY, Wu KY, Yang CH. The impact of the duration of an untreated episode on improvement of depression and somatic symptoms. Neuropsychiatr Dis Treat. 2015;11:2245-2252. doi:10.2147/NDT.S89498 DOI: https://doi.org/10.2147/NDT.S89498

Dagani J, Signorini G, Nielssen O, et al. Meta-analysis of the Interval between the Onset and Management of Bipolar Disorder. Can J Psychiatry. 2017;62(4):247-258. doi:10.1177/0706743716656607 DOI: https://doi.org/10.1177/0706743716656607

Van Meter AR, Burke C, Youngstrom EA, Faedda GL, Correll CU. The Bipolar Prodrome: Meta-Analysis of Symptom Prevalence Prior to Initial or Recurrent Mood Episodes. J Am Acad Child Adolesc Psychiatry. 2016;55(7):543-555. doi:10.1016/j.jaac.2016.04.017 DOI: https://doi.org/10.1016/j.jaac.2016.04.017

Albert U, Barbaro F, Bramante S, Rosso G, De Ronchi D, Maina G. Duration of untreated illness and response to SRI treatment in Obsessive-Compulsive Disorder. Eur Psychiatry. 2019;58:19-26. doi:10.1016/j.eurpsy.2019.01.017 DOI: https://doi.org/10.1016/j.eurpsy.2019.01.017

Benatti B, Camuri G, Dell’Osso B, et al. Which factors influence onset and latency to treatment in generalized anxiety disorder, panic disorder, and obsessive-compulsive disorder? Int Clin Psychopharmacol. 2016;31(6):347-352. doi:10.1097/YIC.0000000000000137 DOI: https://doi.org/10.1097/YIC.0000000000000137

Kisely S, Scott A, Denney J, Simon G. Duration of untreated symptoms in common mental disorders: Association with outcomes. Br J Psychiatry. 2006;189(JULY):79-80. doi:10.1192/bjp.bp.105.019869 DOI: https://doi.org/10.1192/bjp.bp.105.019869

Fusar-Poli P, Schultze-Lutter F, Cappucciati M, et al. The Dark Side of the Moon: Meta-analytical Impact of Recruitment Strategies on Risk Enrichment in the Clinical High Risk State for Psychosis. Schizophr Bull. 2016;42(3):732-743. doi:10.1093/schbul/sbv162 DOI: https://doi.org/10.1093/schbul/sbv162

Fusar-Poli P, Sullivan SA, Shah JL, Uhlhaas PJ. Improving the Detection of Individuals at Clinical Risk for Psychosis in the Community, Primary and Secondary Care: An Integrated Evidence-Based Approach. Front psychiatry. 2019;10:774. doi:10.3389/fpsyt.2019.00774 DOI: https://doi.org/10.3389/fpsyt.2019.00774

Fusar-Poli P, Werbeloff N, Rutigliano G, et al. Transdiagnostic Risk Calculator for the Automatic Detection of Individuals at Risk and the Prediction of Psychosis: Second Replication in an Independent National Health Service Trust. Schizophr Bull. 2019;45(3):562-570. doi:10.1093/schbul/sby070 DOI: https://doi.org/10.1093/schbul/sby070

Green AC, Hunt C, Stain HJ. The delay between symptom onset and seeking professional treatment for anxiety and depressive disorders in a rural Australian sample. Soc Psychiatry Psychiatr Epidemiol. 2012;47(9):1475-1487. doi:10.1007/s00127-011-0453-x DOI: https://doi.org/10.1007/s00127-011-0453-x

Kamaradova D, Latalova K, Prasko J, et al. Connection between self-stigma, adherence to treatment, and discontinuation of medication. Patient Prefer Adherence. 2016. doi:10.2147/PPA.S99136 DOI: https://doi.org/10.2147/PPA.S99136

Downloads

Published
2020-05-20
Info
Issue
Section
Special Section: Clinical high risk for mental illness
Keywords:
Prevention, early intervention, help-seeking, appropriateness, need for treatment, pathway to care
Statistics
  • Abstract views: 335

  • PDF: 218
  • HTML: 0
How to Cite
Solmi, M., Campeol, M., Gentili, F., Favaro, A., & Cremonese, C. (2020). Clinical presentation and need for treatment of a cohort of subjects accessing to a mental illness prevention service. Research in Psychotherapy: Psychopathology, Process and Outcome, 23(1). https://doi.org/10.4081/ripppo.2020.434