Clinical high at-risk mental state in young subjects accessing a mental disorder prevention service in Italy. (October 2022)

• Record Type: Journal Article
• Authors: Monego, Enrico; Cremonese, Carla; Gentili, Federica; Fusar-Poli, Paolo; Shah, Jai L; Solmi, Marco
• Is Part Of: Psychiatry research. Volume 316(2022)
• Publication Date: 2022-10
• Subjects: Transdiagnostic -- Ultra-high risk -- At risk mental state -- Psychosis -- Borderline personality disorder -- Bipolar disorder -- Depression; Psychiatry -- Periodicals; Psychiatry -- periodicals; Psychiatrie -- Périodiques; 616.89
• DOI: 10.1016/j.psychres.2022.114710
• Languages: English
• ISSNs: 0165-1781

Abstract

Highlights: This is the first study applying clinical high at-risk state criteria in an external site. We show that help-seeking adolescents and young adults meet multiple CHARMS categories. We show that depressive symptoms and functioning worsen when meeting criteria for multiple conmitant CHARMS categories, but not psychotic symptoms. Psychotic symptoms explain poor functioning, and not depressive symptoms or CHARMS categories. Abstract: We aim to assess how functioning, depressive symptoms, and psychotic symptoms are associated with different numbers of Clinical High At-Risk Mental State (CHARMS) categories. In this cross-sectional study, we assessed 62 help-seeking subjects aged 15-24 with a drop in functioning, with Structured Clinical Interview for DSM-5, Social and Occupational Functioning Assessment Scale (SOFAS), Comprehensive Assessment of At-Risk Mental State to define risk for psychosis, Hamilton Depression Rating scale (HAM-D), Positive and Negative Symptoms Scale, 6 items (PANSS-6). CHARMS criteria were assessed via retrospective chart review. Overall, 30.6% did not meet any CHARMS component criteria at baseline (CHARMS-), 27.4%, 33.9% and 8.1% met one, two, and three or more CHARMS groups. Overall, 48.8% met criteria for ultra-high risk for psychosis (17.7% without other CHARMS categories), 25.8% risk of borderline personality disorder (3.2% alone), 35.5% mild depression (8.1% alone), 11.3% risk of bipolar disorder (1.6% alone). SOFAS score and HAM-D score worsened from CHARMS- to three or more CHARMS categories, whilst PANSS-6 score did not. In a multivariate regression only PANSS-6 (beta=-1.105, p<0.001) was associated with SOFAS (R 2 =0.385). Help-seeking youth with poor functioning present symptoms meeting CHARMS criteria. Meeting criteria for multiple CHARMS categories is associated with increased depressive, but not psychotic symptoms, while psychotic symptoms play a prominent role in determining functional impairment. Results should be interpreted within the limitations of the study including the small sample size and the cross-sectional design, and need further replications.