TY - JOUR
T1 - Early intervention service systems for youth mental health
T2 - integrating pluripotentiality, clinical staging, and transdiagnostic lessons from early psychosis
AU - Shah, Jai L
AU - Jones, Nev
AU - van Os, Jim
AU - McGorry, Patrick D
AU - Gülöksüz, Sinan
N1 - Funding Information:
JLS is supported by a clinician-scientist salary award from the Fonds de Recherche du Québec–Santé. PDM is supported by a National Health and Medical Research Council Senior Principal Research Fellowship, Australia.
Publisher Copyright:
© 2022 Elsevier Ltd
PY - 2022/5
Y1 - 2022/5
N2 - Challenges associated with operationalising services for the at-risk mental state for psychosis solely in that same diagnostic silo are increasingly well recognised-namely, the differential risk for psychosis being a function of sampling enrichment strategies, declining transition rates to psychosis, questions regarding the validity of transition as an outcome, and the frequent development of non-psychotic disorders. However, recent epidemiological and clinical research suggests that not all threshold-level psychoses are likely to occur homotypically; early-stage non-psychotic syndromes might exhibit heterotypic shifts to a first episode of psychosis, without an identifiable at-risk mental state. These findings, along with the relevance of outcomes beyond traditional diagnoses or syndromes, have substantive implications for developing next-generation early intervention infrastructures. Along with the idea of general at-risk clinics for early-stage pluripotential syndromes, we examine how this reality might affect service design, such as the need for close linkage with centres of expertise for threshold-level disorders when transitions to later stages occur, the balance between generic and specific interventions amid the need for person-centred care, and the challenges this reorientation might pose for broader mental health systems.
AB - Challenges associated with operationalising services for the at-risk mental state for psychosis solely in that same diagnostic silo are increasingly well recognised-namely, the differential risk for psychosis being a function of sampling enrichment strategies, declining transition rates to psychosis, questions regarding the validity of transition as an outcome, and the frequent development of non-psychotic disorders. However, recent epidemiological and clinical research suggests that not all threshold-level psychoses are likely to occur homotypically; early-stage non-psychotic syndromes might exhibit heterotypic shifts to a first episode of psychosis, without an identifiable at-risk mental state. These findings, along with the relevance of outcomes beyond traditional diagnoses or syndromes, have substantive implications for developing next-generation early intervention infrastructures. Along with the idea of general at-risk clinics for early-stage pluripotential syndromes, we examine how this reality might affect service design, such as the need for close linkage with centres of expertise for threshold-level disorders when transitions to later stages occur, the balance between generic and specific interventions amid the need for person-centred care, and the challenges this reorientation might pose for broader mental health systems.
KW - Adolescent
KW - Early Intervention, Educational
KW - Early Medical Intervention
KW - Humans
KW - Mental Health
KW - Psychotic Disorders/diagnosis
KW - Syndrome
UR - http://www.scopus.com/inward/record.url?scp=85128329296&partnerID=8YFLogxK
U2 - 10.1016/S2215-0366(21)00467-3
DO - 10.1016/S2215-0366(21)00467-3
M3 - Review article
C2 - 35430004
SN - 2215-0366
VL - 9
SP - 413
EP - 422
JO - The Lancet Psychiatry
JF - The Lancet Psychiatry
IS - 5
ER -