Hi all, my name is Lauren and I'm a 3rd semester Family Psychiatric NP student at the University of Akron. We are doing a presentation later on in the semester for our class and I was assigned the topic of Psychotic Disorders. After doing some research on this topic I noticed a trend in the literature and a heavy focus on the treatment of these individuals in the Prodromal phase. The following blog post pertains to this topic as I found it to be interesting, and am seeking opinions and responses from providers that I can possibly use to supplement my presentation.
According to the new DSM-V criteria for the Schizophrenia spectrum diagnoses, Attenuated Psychosis Syndrome can now be found in section III. Criteria for this disorder highlights attenuated symptoms of delusions and hallucinations with relatively intact reality testing, symptoms that are infrequent or insufficient in intensity to meet full criteria for a psychotic disorder, and symptoms that typically resolve on their own in the absence of treatment (APA, 2013; Tiffin & Welsh, 2013). It has been widely studied and is well-known that this prodromal/attenuated period is often the precursor for an acute full-blown psychotic episode, with 30-40% of these individuals transitioning to psychosis within two years (Tiffin & Welsh, 2013).
With Schizophrenia spectrum diagnoses being linked to high rates of morbidity, mortality, and decreased quality of life; as well as increasingly burgeoning health care expenses, many experts believe that by targeting this prodromal phase we can identify those at high risk for these disorders and create early preventative strategies to halt the progression to full psychosis. The current state of evidence on whether to treat these individuals with medication at this stage is mixed, with some arguing that the risks associated with anti-psychotics outweigh the benefits (Lachman, 2014).
Questions I would like to pose to the forum include:
- As a prescriber, what is your experience with treating individuals in the prodromal phase with medications? If you felt an individual was at very high risk for developing a psychotic disorder and was experiencing attenuated symptoms would you begin pharmacotherapy, or wait until a diagnosed psychotic disorder developed? What medications and dosages would be the indicated first line treatment during this phase or upon the patient's "first break"?
- What preventative interventions, both inpatient and outpatient, are available to these patients (these can include types of therapy, cognitive remediation, skills training, psychoeducation, etc.) in your practice?
- What are some of the screening tools utilized in your practice to identify at risk patients? It appears from the literature that the Structured Interview for Prodromal Syndromes (SIPS) and the Prodromal Questionnaire-Brief (PQ-B) are the most commonly used screening tools in the U.S. Has anyone had experience in administering either of these screening tools and what is your opinion on the validity/reliability in their being able to correctly identify those patients who go on to develop psychosis?
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Lachman, A. (2014). New developments in diagnosis and treatment update: Schizophrenia/first episode psychosis in children and adolescents. Journal of Child & Adolescent Mental Health, 26(2), 109-124.
Tiffin, P. A., & Welsh, P. (2013). Practitioner review: Schizophrenia spectrum disorders and the at‐risk mental state for psychosis in children and adolescents–evidence‐based management approaches. Journal of Child Psychology and Psychiatry, 54(11), 1155-1175.
Some supplemental information on this topic can be found at:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2930984/
http://www.health.gov.bc.ca/library/publications/year/misc/Psychosis_Identification.pdf