Improving Accuracy of Screening for Clinical High-Risk for Psychosis in an Adolescent Population Seeking Help through the MGH Resilience Evaluation-Social Emotional Training (RE-SET) Program

Jacqueline Clauss, MD, PhD* (1), Cheryl Y. S. Foo, PhD* (1,2), Lauren Utter, PsyD (1), Drew Coman, PhD (1), Michaela Newton, MA (1,3), Kamila Bhiku (1,2), Julia London (1,2), Abigail Donovan, MD (1), Corinne Cather, PhD (1,2), Daphne Holt, MD, PhD (1)

1. Psychosis and Clinical Research Program, Department of Psychiatry, Massachusetts General Hospital;
2. Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital
3. Clinical Psychology Department, William James College;
*Authors contributed equally.

Abstract:

Introduction: Young people with brief or attenuated psychotic symptoms may meet criteria for the clinical high-risk state for psychosis (CHR-P), a syndrome associated with enhanced risk for developing psychotic disorders and other impairing psychiatric illnesses. The MGH Resilience Evaluation-Social Emotional Training (RE-SET) program provides evaluation, prognostic assessment, and preventative treatment for CHR-P individuals (ages 12-30). CHR-P’s high comorbidity and overlap in clinical features with other psychiatric symptoms presents challenges for early and accurate identification of CHR-P. Improving identification of CHR-P individuals could facilitate more timely referrals and reduce evaluation burden.

Method: Family members, clinical providers, or patients self-referring to RE-SET completed a screening form assessing patient’s lifetime behaviors, psychiatric diagnosis, psychiatric service use, and the Adolescent Psychotic-like Symptom Screener (APSS). Prior to a two-part clinical evaluation, eligible patients and their caregivers completed a battery of measures of symptoms of psychosis, anxiety, attention, and mood; traumatic experiences; social functioning; caregiver burden; and developmental history. Following an initial diagnostic evaluation, if there was evidence for attenuated or brief psychotic symptoms, clients the completed the Structured Interview for Psychosis-Risk Syndromes, a gold-standard assessment to determine CHR-P status. We used hierarchical logistic regression to determine predictive ability and incremental validity of clinical risk factors to detect CHR-P status.

Results: 98 help-seeking adolescents (mean age: 18.1; SD: 4.1) were assessed. 24 (24.5%) met CHR-P criteria. Referrals had high rates of psychiatric comorbidity at time of referral: 73.5% had at least one reported psychiatric diagnosis and 62.2% had been treated with a psychotropic medication. Evaluated patients (n=43) reported moderate levels of perceived stress, loneliness, and depression, and severe anxiety symptoms, consistent with the transdiagnostic nature of this population. Referrer-reported decline in social functioning in the past year (OR=6.54, p=.038), autism spectrum disorder (ASD) diagnosis (OR=16.21, p=.026), and endorsing at least two APSS items (OR=9.52, p=.011) predicted CHR-P status (model R2= .43, p = .008). Self-reported hours awake per day improved prediction of CHR-P over the above variables (OR=4.41, p=.016; model ΔR2 = .306, p=.002).

Conclusions: Potential CHR-P individuals present with high diagnostic complexity and significant clinical need. A recent decline in social functioning, an ASD diagnosis, attenuated symptoms, and less sleep are significant risk factors for CHR-P status; screening and evaluation of CHR-P can be improved with greater attention to these factors.