Evaluation of Schizophrenia spectrum disorders
Schizophrenia spectrum disorders and other psychotic disorders are defined by anomalies in one or more of the following domains: delusions, hallucinations, disorganized thought (speech), very disorganized or anomalized motor behavior (including catatonia) and negative symptoms.
In recent decades there has been a transition in the characterization of psychotic diseases. To allow the identification of subjects with an increased potential of ‘imminent development of a first episode of psychotic disorder’, a concept that defines a high -risk mental state for psychosis (EMAR) has been created to refer to the pre -psychotic phase, describingTo people who have prodromic symptoms. EMAR criteria have been adapted for use worldwide and have been called, in a variable way, the UHR (in English, Ultra-High Risk Psychosis), the high-risk clinical state, the mental state of risk or theProdromic criteria.
The importance of this stage of psychosis has been increasing. The criteria that are proposed in the DSM-5 for diagnosis include that at least one of the following symptoms is present in a attenuated manner, with a relatively intact reality judgment, and is sufficient seriously or frequency to justify clinical attention:delusions, hallucinations and disorganized speech. Symptoms must have been present at least once a week during the last month, they must have started or worsened in the last year, they must be distressing and disabling for the individual to justify clinical attention and should not be better explained by anothermental disorder or by the physiological effects of one substance or another medical condition. Criteria for any psychotic disorder should not be fulfilled.
This category was introduced with the objective of developing treatments for the prevention of psychotic disorders. However, its function as a diagnosis is the subject of debate. Therefore, the prodromic symptoms and signs of psychosis are considered pleiotropic and are related to several possible results, including the development of non -psychotic disorders, instead of being exclusive to psychotic disorders. Thus, the syndrome proposed in the DSM-5 can be considered analogous to chest pain (a condition that requires diagnosis and treatment and that possibly indicates a myocardial infarction, but also a sign of possible pulmonary embolism, pneumothorax, panic attack or refluxgastroesophageal) instead of hyperlipidemia (an asymptomatic myocardial infarction risk factor).
The original EMAR criteria require that a young person between 14 and 30 years of age sent for mental health problems meets the criteria of one or more of the following groups: (3,20,21)
- The APS Group: Those who have experienced subsurio, PSA positive in the last year.
- The Blips Group (in English, Brief Limited Psychotic Symptom): Those who have experienced episodes of psychic symptoms that have not lasted more than a week and have decreased spontaneously (that is, without treatment).
- The risk factors group: those who have a first -degree relative with a psychotic disorder or the patient has a schizotypal personality disorder in addition to a significant decrease in functioning or low chronic functioning in the last year.
Different interview measures have been developed to evaluate the characteristics of the EMAR and determine if people meet the criteria, mainly, the integral evaluation of the mental state of risk (CAARMS) (2) and the structured interview for prodromal symptoms (SIPS).
Since all EMAR criteria are based on the search for help, the prevalence of EMAR is unknown in the general population.
A key concept that arises is that, although people with potentially prodromic characteristics run a much higher risk of suffering a psychotic disorder (in most cases in a relatively short period), less than 40% will really develop it. The risk of transition to psychosis in samples of EMAR individuals has varied between studies, and risks have decreased in recent years. In a meta-analysis (24) of approximately 2500 EMAR individuals, it was shown that there was an average risk (95% IC) transition, independent of the psychometric instruments used, 18% (12% -25%) at 6 monthsof follow-up, 22%(17%-28%) to 1 year, 29%(23%-36%) to 2 years, 32%(24%-35%) to 3 years, and 36%(30%-43%) after 3 years. It is likely, therefore, that there is a critical period of transition to psychosis, which is greater in the first months. This may have implications in their treatment, since patients who make the transition have symptoms that have an impact on a worse quality of life.
Among the possible causes of the apparent decrease in transition risks are the following: 1) The treatment of EMAR patients that prevents or delays the appearance of psychosis;2) a waiting time bias, that is, the early detection that gives rise to transitions that apparently occur later;and 3) a dilution effect, that is, more ‘false positives’ that do not really run the risk, which are sent to EMAR services, possibly as a result of those services and their admission criteria being better known.
Preventive interventions in psychosis are feasible and can be effective. Most essays indicate clinically significant advantages of focused treatment (psychological, psychopharmacological or neuroprotective interventions) compared to the respective contrast groups. In a recent exam (26) of the efficacy of treatment in EMAR. However, no reliable recommendations can be made on whether psychosocial interventions, such as cognitive-behavioral (TCC) therapy;potentially neuroprotective agents, such as fatty acids Ω-3;or antipsychotic agents are more effective for the prevention of psychosis in EMAR.
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