Pluripotential Risk and Clinical Staging

Theoretical Considerations and Preliminary Data From a Transdiagnostic Risk Identification Approach

Bibliographic Data

ID15524309
AuthorsJessica Hartmann (0000-0001-7662-6155, The University of Melbourne, corresponding author), Jessica A Hartmann, Patrick D Mcgorry (0000-0002-3789-6168, Orygen), Louise Destrée (0000-0002-0942-7241, Monash University), G Paul Amminger (Orygen), Andrew M Chanen (0000-0003-4468-622X, The University of Melbourne), Christopher G Davey (0000-0003-1431-3852, Orygen), Rachid Ghieh (The University of Melbourne), Andrea Polari (0000-0002-0680-3192, The University of Melbourne), Aswin Ratheesh (0000-0002-8029-9422, The University of Melbourne), Hok Pan Yuen (0000-0002-1237-1322, Orygen), Barnaby Nelson (0000-0002-6263-2332, Orygen)
Year2021
Volume11
Pages553578-553578
Publication date2021-01-08
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueFrontiers in Psychiatry (JOURNAL)
Journal identifiersISSN: 1664-0640 • E-ISSN: 1664-0640
PublisherFrontiers Media (PUBLISHER • CH)
DOI10.3389/fpsyt.2020.553578
PMID33488413
OpenAlexW3118839636
LanguageEN
Citations received4
References cited106

Most psychiatric disorders develop during adolescence and young adulthood and are preceded by a phase during which attenuated or episodic symptoms and functional decline are apparent. The introduction of the ultra-high risk (UHR) criteria two decades ago created a new framework for identification of risk and for pre-emptive psychiatry, focusing on first episode psychosis as an outcome. Research in this paradigm demonstrated the comorbid, diffuse nature of emerging psychopathology and a high degree of developmental heterotopy, suggesting the need to adopt a broader, more agnostic approach to risk identification. Guided by the principles of clinical staging, we introduce the concept of a pluripotent at-risk mental state. The clinical high at risk mental state (CHARMS) approach broadens identification of risk beyond psychosis, encompassing multiple exit syndromes such as mania, severe depression, and personality disorder. It does not diagnostically differentiate the early stages of psychopathology, but adopts a "pluripotent" approach, allowing for overlapping and heterotypic trajectories and enabling the identification of both transdiagnostic and specific risk factors. As CHARMS is developed within the framework of clinical staging, clinical utility is maximized by acknowledging the dimensional nature of clinical phenotypes, while retaining thresholds for introducing specific interventions. Preliminary data from our ongoing CHARMS cohort study ( N = 114) show that 34% of young people who completed the 12-month follow-up assessment ( N = 78) transitioned from Stage 1b (attenuated syndrome) to Stage 2 (full disorder). While not without limitations, this broader risk identification approach might ultimately allow reliable, transdiagnostic identification of young people in the early stages of severe mental illness, presenting further opportunities for targeted early intervention and prevention strategies

Bipolar disorder · Identification (biology · Mania · Mood · Prodrome · Psychiatry · Psychological intervention · Psychopathology · Psychosis · Schizophrenia (object-oriented programming · Bipolar Disorder and Treatment · Clinical Psychology · Mental Health Research Topics · Psychology · Schizophrenia research and treatment

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