Identifying adolescents in the early stage of psychosis: A screening checklist for referrers.

OBJECTIVE: The early identification of adolescents at the onset of psychosis is crucial to provide effective interventions. The aim of this study is to examine the validity of the "early detection Primary Care Checklist" (PCC) in an Italian adolescent population. The PCC is a 20-item tool designed to assist primary care practitioners in identifying young people with early psychosis. METHODS: The checklist was completed by the referring practitioners of 129 adolescents. The validity of this instrument was established by comparing screen results with the "Comprehensive Assessment of At-Risk Mental States." RESULTS: The simple checklist had excellent 98% sensitivity, but low specificity (58%). Using only a PCC total score of ≥20 as cutoff, there was a substantial improvement in specificity (87%). CONCLUSION: The Italian version of the PCC performed well to identify adolescents in the early stage of psychosis and may be used in primary care settings.

Assessing aberrant salience in young community help-seekers with early psychosis: The approved Italian version of the Aberrant Salience Inventory.

OBJECTIVES: Aberrant salience (AS) has a crucial role in the onset of psychosis. The Aberrant Salience Inventory (ASI) is the only self-report instrument specifically developed for the assessment of AS. Aim of this study was to examine the reliability and the validity of the approved Italian version of the ASI in a clinical sample of young help-seekers. METHODS: The ASI was completed by 204 individuals, aged 13-35 years. Reliability was assessed examining internal consistency and test-retest reliability. Concordant validity was established with CAARMS ("Comprehensive Assessment of At-Risk Mental States"). RESULTS: The ASI showed high test-retest reliability and excellent internal consistency. The ASI total score had significant positive correlations with CAARMS "Positive Symptoms" subscores. CONCLUSIONS: The ASI showed satisfactory psychometric properties and seems to be a suitable instrument for early detection of psychosis in Italian mental health services.

Anhedonia in adolescents at ultra-high risk (UHR) of psychosis: findings from a 1-year longitudinal study.

Previous findings suggested deficits in pleasure experience in schizophrenia, but little is known in psychosis risk prodrome, especially in adolescence. Aim of this study was (1) to assess anhedonia in distinct help-seeking subgroups of adolescents identified through the ultra-high risk (UHR) criteria, (2) to explore any association of anhedonia with other psychopathological aspects in the UHR group, and (3) to monitor longitudinally the stability of anhedonia in UHR individuals across 1-year follow-up period. 123 participants (13-18 years) completed the Comprehensive Assessment of At-Risk Mental States (CAARMS), the Beck Depression Inventory-II, the Schizotypal Personality Questionnaire-Brief version, the Brief-O-LIFE questionnaire (BOL), and the Brief version of the World Health Organization Quality of Life scale (WHOQOL-BREF). Two different indexes of anhedonia were used: CAARMS "Anhedonia" item 4.3 and BOL "Introvertive Anhedonia" subscale scores. No difference in anhedonia levels between UHR and First Episode Psychosis (FEP) groups was found. UHR adolescents showed higher CAARMS and BOL anhedonia scores than non-UHR/FEP. After 1-year follow-up period, UHR adolescents had a significant decrease in severity only in CAARMS anhedonia subscores. In UHR subgroup, CAARMS anhedonia measures showed significant correlations with impaired role functioning and negative symptoms, while BOL anhedonia was significantly correlated with specific schizotypal personality traits concerning interpersonal deficits. Anhedonia is prominent in the psychosis prodrome, also in adolescence. Its severity is not statistically different from that of FEP adolescents and is related to more severe functioning impairment and a worse quality of life.

The "Reggio Emilia At-Risk Mental States" program: A diffused, "liquid" model of early intervention in psychosis implemented in an Italian Department of Mental Health.

AIM: From September 2012, the Reggio Emilia Department of Mental Health developed a specific program (the "Reggio Emilia At-Risk Mental States" [ReARMS] protocol) as a diffused, "liquid" infrastructure for early intervention in psychosis. Aims of the current study are (a) to describe the ReARMS macroscopic organization and (b) to examine specific process indicators during the first 5 years of clinical activity. METHODS: All participants (n = 300) were young help-seekers, aged 13 to 35 years, who completed the Comprehensive Assessment of At-Risk Mental States (CAARMS). RESULTS: At baseline, 95 (31.7%) participants did not meet CAARMS-defined criteria, while 205 (68.3%) were offered a dedicated protocol of care: 154 (75.1%) of them were enrolled in the program, 19 (9.3%) refused and 32 (15.6%) dropped out during the first year of treatment. Individuals enrolled in the ReARMS protocol were mainly referred by general practitioners (33.3%), emergency room/general hospital (24%) or they were self-referred (15%). In comparison with ultra-high risk individuals, patients with first episode psychosis showed significantly higher mean age at entry and preponderance of males, as well as higher percentages of history of substance abuse and previous hospitalization. CONCLUSIONS: An early intervention in psychosis service in Italian child/adolescent and adult mental health services are feasible and clinically relevant, also in adolescents, who have a high risk of falling through the child-adult service gap as they cross the transition boundary between services.