Clinical high risk for psychosis paradigm for CAP: do not throw the baby out with the bathwater
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LETTER TO THE EDITOR
Clinical high risk for psychosis paradigm for CAP: do not throw the baby out with the bathwater Paul Klauser1,2 · Alexis Revet3,4 · Dimitri Anagnostopoulos5 · Johannes Hebebrand6 · Carmen Moreno7 · Jean‑Philippe Raynaud3,4 · Marco Armando8 Received: 4 August 2020 / Accepted: 18 August 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
We would like to thank Rimvall and colleagues for their comments [1] regarding our recent editorial on the deployment of clinical high risk for psychosis (CHR-P) paradigms in child and adolescent psychiatry (CAP). We take this opportunity to precisely clarify the purpose of our statement and to enrich this important debate. First, Rimvall and colleagues present CHR-P and patientcentered approaches as antinomic and mutually exclusive. This dichotomy is not supported by the current state of research in CHR-P. Recent models integrate CHR-P with precision as well as patient-centered medicine (e.g. Psychosis Polyrisk Scores (PPS), including genetic and non-genetic information [2]).
* Marco Armando [email protected] 1
Service of Child and Adolescent Psychiatry, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
2
Department of Psychiatry, Center for Psychiatric Neuroscience, Lausanne University Hospital, Lausanne, Switzerland
3
Service Universitaire de Psychiatrie de L’Enfant Et de L’Adolescent, CHU de Toulouse, Toulouse, France
4
UMR 1027, Inserm, Université Toulouse III, Toulouse, France
5
Medical School, National and Kapodistrian University of Athens, Athens, Greece
6
Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, LVR Klinikum Essen, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
7
Child & Adolescent Psychiatry Department Hospital General, Universitario Gregorio Marañón, Madrid, Spain
8
Department of Psychiatry, Developmental Imaging and Psychopathology Lab, University of Geneva, Geneva, Switzerland
Second, Rimvall and colleagues refer to some of their recent findings from epidemiological studies on psychoticlike experiences (PLEs) that mainly rely on self-ratings or standardized lay-person interviews. As already emphasized elsewhere [3], PLEs are not an adequate proxy for attenuated psychotic symptoms and brief intermittent psychotic symptoms criteria (APS/BIPS) examined in CHR-P studies. The conclusion that psychotic experiences are “a transdiagnostic dimension of psychopathology” and “a marker for the severity of non-psychotic states” should be viewed with great caution when applied to APS/BIPS assessed in CHR-P research. That said, our editorial was not meant to present a comprehensive review of the CHR-P paradigm, and there is indeed a healthy debate about the pertinence and clinical utility of the CHR-P approach in young adults (see for example [3, 4]). In this context, we understand the concerns of Rimvall and colleagues about our proposal to deploy the CHR-P model in CAP. Recent meta-analyses [5] show the beneficial effects
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