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IEPA clinical practice guidelines for ARMS Shôn Lewis University of Manchester UK. Early phase terminology. High risk Psychosis proneness; schizotypy Isolated psychotic symptoms Psychosis like experiences Non-clinical/subclinical psychotic symptoms Early prodromal Bonn scale

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iepa clinical practice guidelines for arms sh n lewis university of manchester uk

IEPA clinical practice guidelines for ARMSShôn LewisUniversity of Manchester UK

early phase terminology
Early phase terminology
  • High risk
    • Psychosis proneness; schizotypy
  • Isolated psychotic symptoms
    • Psychosis like experiences
    • Non-clinical/subclinical psychotic symptoms
  • Early prodromal
    • Bonn scale
  • At risk mental state
    • Late prodromal
  • First episode psychosis
early phase terminology3
Early phase terminology
  • High risk
    • Psychosis proneness; schizotypy
  • Isolated psychotic symptoms
    • Psychosis like experiences
    • Non-clinical/subclinical psychotic symptoms
  • Early prodromal
    • Bonn scale
  • At risk mental state
    • Late prodromal
  • First episode psychosis
early phase terminology4
Early phase terminology
  • High risk
    • OLIFE; SPQ
  • Isolated psychotic symptoms
    • LSHS
    • PDI; CAPE
  • Early prodromal: SPIA
  • At risk mental state
    • CAARMS
    • SIPS/SoPS
  • First episode psychosis
    • PANSS etc
at risk mental state yung et al 1998
At risk mental state: Yung et al 1998
  • Attenuated positive symptoms
    • subthreshold for severity
  • Brief limited intermittent psychotic symptoms
    • subthreshold for duration (<1 week)
  • Schizotypal personality or first degree relative with psychosis plus recent functional deterioration
  • Seeking help
high risk of acronyms
High risk of acronyms
  • PACE
  • PRIME
  • EDIE
  • RAP
  • FETZ
  • TOPP
  • PIER
  • OASIS
  • EPOS
  • CARE
  • NAPLS
  • SPAM
    • Society for Prevention of Acronyms in Mental health
iepa clinical guidelines for early psychosis
IEPA clinical guidelines for early psychosis
  • Formulated Copenhagen 2002
  • 29 authors A-Y
  • Published 2005
  • To be updated 2008
  • Covered
    • ARMS
    • First episode
    • Recovery (6-18 months) and critical period phase

IEPA writing group Br J Psychiatry 2005 187 s48 s120-124

prevention in early psychosis
Prevention in early psychosis
  • Three targets for preventative interventions in early psychosis
    • Prepsychotic phase
    • Initially untreated psychosis
    • First episode

IEPA writing group Br J Psychiatry 2005 187 s48 s120-124

general statements
General statements
  • Early identification will reduce burden
    • May improve long term outcomes
  • Public education important
  • Careful, low dose drug treatment in first episode
  • Psychosocial treatments important in promoting recovery
  • Users and families engaged in developing better treatments

IEPA writing group Br J Psychiatry 2005 187 s48 s120-124

the prepsychotic period clinical guidelines
The prepsychotic period: clinical guidelines
  • At risk mental state needs to be considered in young people with deteriorating functioning or unexplained agitation

IEPA writing group Br J Psychiatry 2005 187 s48 s120-124

the prepsychotic period clinical guidelines18
The prepsychotic period: clinical guidelines
  • Help seeking people with ARMS need to be engaged and assessed and offered
    • Regular monitoring and support
    • Specific treatment for depression or substance use
    • Psychoeducation and help to develop coping skills
    • Family education and support
    • Information about risks of psychosis

IEPA writing group Br J Psychiatry 2005 187 s48 s120-124

the prepsychotic period clinical guidelines19
The prepsychotic period: clinical guidelines
  • Care offered in a low stigma environment
    • At home; primary care; youth-friendly office-based setting
  • Antipsychotic drugs not usually indicated
    • Exceptions might be risk of suicide or violence, or rapid deterioration
    • If used, regard as therapeutic trial for up to 6 weeks
  • If help declined, consider support from friends and family

IEPA writing group Br J Psychiatry 2005 187 s48 s120-124

issues for arms interventions
Issues for ARMS interventions
  • Safety and acceptability
  • Efficacy and effectiveness
  • Availability and cost
  • What is the therapeutic target?
    • Prevention versus treatment
  • Ethics
    • Of treatment; Of non-treatment
  • Population impact

IEPA writing group Br J Psychiatry 2005 187 s48 s120-124

issues for arms interventions22
Issues for ARMS interventions
  • Refinement of risk estimates
  • Modifying risk and protective factors
  • Developing a clinical algorithm
    • Psychological intervention first?
    • Drug treatment second?
    • How long for?

IEPA writing group Br J Psychiatry 2005 187 s48 s120-124

which psychological intervention
Which psychological intervention?
  • Cognitive therapy (Morrison et al, 2006; Ruhrman et al, 2007)
  • Also? (from psychosis literature)
    • Family intervention
    • CT for relapse
    • Motivational interventions
    • Cognitive remediation
which drug treatments
Which drug treatments?
  • Antipsychotics?
    • Appear effective
      • RCT data with risperidone; olanzapine; amisulpride
    • BUT risks from side effects: low NNT:NNH ratio
    • Doubtful acceptability for many
  • Antidepressants?
    • Anecdotal evidence
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