How well does psychosis risk criteria predict the transition to psychosis? a 10-year service audit of an early psychosis service

by Agatha Conrad

Institution: University of Newcastle
Year: 2014
Keywords: transition to psychosis; young people
Record ID: 1071908
Full text PDF: http://hdl.handle.net/1959.13/1059832


Professional Doctorate - Doctor of Clinical Psychology (DCP) Background: Over the past 15 years research has focused on the development and validation of specific assessment tools to identify individuals at risk of developing psychosis, and to apply these methods to naturalistically followed high risk cohorts. Further, during this phase, ascertainment and assessment methods have proven sufficiently valid, initial clinical risk markers and predictors of conversion to psychosis have been identified and interventions that can abort or delay the development of full psychosis have been examined. Despite the existence of this body of literature, few studies have sought to document the development, implementation and evaluation of specialised psychosis related services. Assessment of individuals at Ultra High Risk (UHR) has been a consistent focus of attention, but it is equally as important to identify appropriate comparison groups, and to account for other baseline differences. Purpose: This research comprised a ‘layered’ service audit which examined all presentations to Psychological Assessment Service (PAS) during the ten-year period ending December 2007. The term ‘layered’ also reflected the fact that there were variations in the patterns of assessments completed and the availability of different service level outcomes. While the service audit had broad aims, the data used for this study has been selected to examine the following aims; a) Describe the sample of clients who have presented to PAS service over the 10 year period; b) Examine the risk factors for developing a psychosis; c) Examine the relative contribution of UHR to transition to psychosis. Methods: The first paper reported data from a 10-year layered service audit of all presentations to a specialised ‘Psychological Assistance Service’ (PAS) for young people in Newcastle (Australia). Baseline socio-demographic and clinical characteristics of the clients (N = 1,997) are described (including their psychosis and UHR status, previous service contacts, hospitalisation rates, and diagnostic and comorbidity profiles, key groups are identified, and comparisons are made between clients who received ongoing treatment and those who were primarily assessed and referred elsewhere. The second paper reported on five primary outcomes: rates to subsequent psychosis (or transition where appropriate); subsequent comorbidity of depression, anxiety and/ or substance use among the five groups, service use (community contacts, and hospital admissions). The second paper focused on examining the predictors of transition. It is beyond the scope of the thesis to present all the results, while all of the results from paper 1 are included only key findings on psychosis transition rates and associated comorbidity are reported from paper 2. Results: Paper 1 reported on the demographic and clinical characteristics of the sample. The average age of clients was 19.2 (SD = 4.5) years, 59% of whom were male. One-tenth (9.6%) of clients were categorised as UHR, among whom there were…