Early detection of psychosis: findings from the “Reggio Emilia At-Risk Mental States” (ReARMS) program

Primary and secondary prevention strategies have been addressed in several fields of medicine, but early detection in psychiatry still remains a grey zone, also in psychosis. Serious mental illnesses share an early presentation, with a typical beginning during adolescence for the 75% of them. The personal and societal impact of such disorders makes early detection and intervention a crucial issue, in the attempt to prevent significant consequences on individual functioning. Staging models have been developed in order to use a preventative approach, targeted at avoiding the onset and/or progression of serious mental disorders (especially of psychosis), with treatment regimens selected according to stage and individual profile risk factors. Staging allows the introduction of effective treatment in early illness phases, by means of placing individuals on a continuum in the context of the disorder progression. This goes along with the assumption that administering treatments during early illness stages could also modify the individual risk of disease progression. Although the first models were mainly applied to psychosis, the concept of staging has been progressively applied to severe psychiatric disorders, in the attempt to define early clinical phenotypes showing an enhanced risk of progression into chronic and recurrent phases of such disorders. In this research, our interest was focalized on early detection of psychosis (specifically, of adolescents and young adults with First Episode Psychosis [FEP] or at Ultra-High Risk [UHR] of psychosis). A 2-step identification procedure was proposed. For the first (“screening”) step, different instruments were described and were analyzed in their psychometric characteristics. These screeners can also be used in different settings (e.g. the “Checklist per la Valutazione dell’Esordio Psicotico [CVEP] in general medical practice; the Prodromal Questionnaire-Brief version [PQ-B], the 16-item Prodromal Questionnaire [PQ-16] or the Aberrant Salience Inventory [ASI] in triage services allocated in general child/adolescent and adult mental health centers). The second step included an in-depth assessment using clinical interviews specifically developed for the early detection of psychosis and the psychosis risk stratification (such as the CAARMS).