Table 1.
Overview of early intervention for mental disorders in youth.
| Schizophrenia/ Psychotic disorders |
Mood disorders (BP/MDD) |
Personality disorders | Anxiety disorders | Substance abuse | OCD | Eating disorders | |
|---|---|---|---|---|---|---|---|
| Target Population |
CHR-P: [73]**** FEP: [97]**** |
BD: at-risk states*, prodrome (CHR-BP) [84]* |
BPD subthreshold* Early-Stage BPD* [100] |
At-Risk Populations [137]*** Youth [135]*** |
High-Risk Populations [101]*** Youth [138]*** |
Youth [77]** | Recent-Onset ED [102]** |
|
Detection Screening Instruments (Sensitivity/Specificity, PPV, NPV) Duration of Prodrome (months) Duration of Untreated Illness (months) Relationship to Outcome |
CHR-P: CAARMS, SIPS, SPI-A (67–100%, 39–100%, 24–100%) [139]** CHR-P: 21 [140]* FEP: 28–60 [94]*** Psychosis: 24-26 [141]*** FEP: Negative Symptoms, Self-harm [141]*** |
CHR-BP: BPSS-AS-P [142]* MDD: PHQ-9* [143] BP: 27 [74]*** MDD:1-36 [76]*** BP:60 [144]*** MDD:12-60 [145]*** BP: Onset of Mania, Psychosis [144]*** MDD: Treatment Response, Remission [145]*** |
BPD: MSI-BPD, BPQ, SCID-II BPD module (65-91) [146]* – – – |
CMAS, MASC [147]* – GAD: 108* [148] Phobias: 120* [148] PTSD: 120* [148] – |
CRAFFT (.80-86) [149]*** - Alcohol abuse: 108* [148] Alcohol Dependence: 72* [148] Drug Abuse: 72 [148] Drug Dependence: 30 [148]* - |
SOCS (.67) [150]* - OCD: 84-120 [77]** OCD: Treatment Response [77]** |
ED: SCOFF (100%, 87.5%) [151] EDE-Q (82.8%, 89.7%, 0.94) [152]* AN: 30 [95]** BN: 34 [95]** BED: 67 [95]** AN: Persistence of AN [153]* |
|
Prognosis Assessment instruments (accuracy, AUC) Transition Risk Biomarkers Risk Calculators (AUC, C-Index): |
CAARMS [154]***, SIPS [154]*** (0.85 pooled at 38 months)*** CHR-P: 17% at 1 year; 22% at 3 years) [73]*** CHR-P (Transition): Cognition [82]***, MRI [83]***, EEG [155]*** FEP (Functional Outcomes): [156]* CHR-P (Psychosis Risk): (0.70–0.80) [8]*** |
BPSS-FP (not available) SIBARS (0.7 at 18 months) [157]* 14% at 1 year [85]*; 23% at 2 years [85]* BP At-Risk (Transition): (.70) [158]* BP At-Risk (Onset of BD): (.71) [8] |
– – – – |
– – – – |
– – – – |
– – – – |
– – – – |
|
Interventions (level of evidence) Indicated Prevention Secondary Prevention |
CHR-P: CBT (reduction in transition to psychosis) [98]1b FEP: Specialized EI- Services (psychosocial and pharmacological interventions: significant effects on functional and clinical outcomes) [97] 1b |
BP At-Risk: Pharmacology, Psycho-Social Interventions (no effect on transition, moderate effect on depression) [159]1b MDD: School-based interventions (small effect on symptoms) [160] MDD (Youth): Psycho-Social Interventions (no effect on onset but possible reduction of symptoms) 1b |
– Early-Stage BPD: EI Service Model (psychotherapy, befriending: greater treatment attendance/completion), [13]1c |
School-Based Interventions: (small effect on symptoms) [161]1b Psychological/Educational Interventions: (small, preventive effect) [162]1b – |
Cannabis: School-Based Interventions (small effect on cannabis use) [163]1b Youth with Substance Abuse: Motivational Interviewing (small effects on use) [164]1b Preliminary evidence for self-help/peer and CBT [101]2b |
– – |
Recent Onset ED: Specialized EI Service (improved clinical outcomes, reduction in admissions) [102]2b |
* single study, ** systematic review, *** meta-analysis, **** umbrella review. Level of evidence:
1a) Systematic reviews (with homogeneity) of randomized controlled trials 1b) Individual randomized controlled trials (with narrow confidence interval) 1c) All or none randomized controlled trials 2) a Systematic reviews (with homogeneity) of cohort studies 2b) Individual cohort study or low quality randomized controlled trials (e.g. <80% follow-up) 2c) "Outcomes" Research; ecological studies 3a) Systematic review (with homogeneity) of case-control studies 3b) Individual case-control study 4) Case-series (and poor quality cohort and case-control studies) 5) Expert opinion without explicit critical appraisal, or based on physiology, bench research or "first principles"
AN Anorexia Nervosa, APS attenuated psychotic symptoms, BED Binge Eating Disorders, BLIPS brief limited intermittent psychotic symptoms, BN Bulimia Nervosa, BP Bipolar Disorders, BPD Borderline Personality Disorder, BPSS-AS-P Bipolar Prodrome Symptom Scale - Abbreviated Screen for Patients, BPQ Borderline Personality Questionnaire, BPSS-AP Bipolar Prodrome Symptom Interview and Abbreviated Screen for Patients, BPSS-FP Bipolar Prodrome Symptom Interview and Scale-Full Prospective, CAARMS Comprehensive Assessment of At Risk Mental States, CHR-BP Clinical High-Risk for Bipolar Disorder, CHR-P Clinical High-Risk for Psychosis, CMAS Children’s Manifest Anxiety Scale, CBT Cognitive Behavioral Therapy, CRAFFT Car, Relax, Alone, Forget, Friends, Trouble Questionnaire, ED Eating Disorders, EDE-Q Eating Disorders Examination Questionnaire, EEG Electroencephalography, FEP First Episode Psychosis, GAD Generalized Anxiety Disorder, GRD genetic risk and deterioration syndrome, MASC Multidimensional Anxiety Scale for Children, MDD Major Depressive Disorder, MSI-BPD McLean Screening Instrument for Borderline Personality Disorder, MRI Magnetic Resonance Imaging, OCD Obsessive Compulsive Disorder, PHQ-9 Patient Health Questionnaire, PTSD Post-traumatic stress disorder, SCID-BPD BPD items from the Structured Clinical Interview for DSM-IV Axis II disorders (SCID-II) Personality Questionnaire, SCOFF Sick, Control, One, Fat, Food Questionnaire, SIBARS Semistructured Interview for Bipolar At Risk States, SIPS Structured Interview for Psychosis-Risk Syndromes, SOCS Self-report Short OCD Screener, SPI-A Schizophrenia Proneness Instrument, Adult version