Epidemiology; Mental Disorders; Psychosis; At-Risk Mental State; Early Detection; Pathways-to-care
Schultze-Lutter Frauke, Ruhrmann Stephan, Michel Chantal, Kindler Jochen, Schimmelmann Benno G., Schmidt Stefanie J. (2020), Age effects on basic symptoms in the community: A route to gain new insight into the neurodevelopment of psychosis?, in European Archives of Psychiatry and Clinical Neuroscience
, 270(3), 311-324.
Michel Chantal, Schmidt Stefanie J., Schnyder Nina, Flückiger Rahel, Käufeler Iljana, Schimmelmann Benno G., Schultze-Lutter Frauke (2019), Associations of psychosis-risk symptoms with quality of life and self-rated health in the Community, in European Psychiatry
, 62, 116-123.
Michel Chantal, Schnyder Nina, Schmidt Stefanie J., Groth Nicola, Schimmelmann Benno G., Schultze-Lutter Frauke (2018), Functioning mediates help-seeking for mental problems in the general population, in European Psychiatry
, 54, 1-9.
Schultze-Lutter Frauke, Michel Chantal, Ruhrmann Stephan, Schimmelmann Benno G. (2018), Prevalence and clinical relevance of interview-assessed psychosis risk symptoms in the young adult community., in Psychological Medicine
Michel Chantal, Schimmelmann Benno G., Schultze-Lutter Frauke (2018), Demographic and clinical characteristics of diagnosed and non-diagnosed psychotic disorders in the community., in Early Intervention in Psychiatry
Schnyder Nina, Michel Chantal, Panczak Radek, Ochsenbein Susann, Schimmelmann Benno G., Schultze-Lutter Frauke (2018), The interplay of etiological knowledge and mental illness stigma on healthcare utilisation in the community: A structural equation model, in European Psychiatry
, 51, 48-56.
Schimmelmann BG, Michel C, Martz-Irngartinger A, Linder C, Schultze-Lutter F (2015), Age matters in the prevalence and clinical significance of ultra-high-risk for psychosis symptoms and criteria in the general population: Findings from the BEAR and BEARS-kid studies., in World Psychiatry
, 14(2), 189-197.
Schultze-Lutter Frauke, Michel Chantal, Ruhrmann Stephan, Schimmelmann Benno G (2014), Prevalence and Clinical Significance of DSM-5-Attenuated Psychosis Syndrome in Adolescents and Young Adults in the General Population: The Bern Epidemiological At-Risk (BEAR) Study., in Schizophrenia Bulletin
, 40(6), 1499-1508.
Michel Chantal, Schimmelmann Benno G, Kupferschmid Stephan, Siegwart Marcel, Schultze-Lutter Frauke (2014), Reliability of telephone assessments of at-risk criteria of psychosis: A comparison to face-to-face interviews, in Schizophrenia Research
, 153(1-3), 251-253.
Schultze-LutterFrauke, SchimmelmannBenno G., FlückigerRahel, MichelChantal, Effects of age and sex on clinical high-risk for psychosis in the community, in World Journal of Psychiatry
Background: Early detection and treatment of persons with first signs of emerging psychosis is currently regarded the most promising strategy to reduce the enormous disability and costs associated with this disease. For an early detection of psychosis, two complementary sets of at-risk criteria are currently used: (1) ‘ultra high risk’ criteria including attenuated psychotic symptoms, brief limited intermittent psychotic symptoms and a combination of a genetic risk factor and a recent persistent significant decline in functioning and (2) the basic symptom criteria ‘cognitive-perceptive basic symptoms’ and ‘cognitive disturbances’. To date, prevention research in psychosis has only been carried out in selected samples of help-seeking at-risk persons that must be assumed a non-representative minority of the at-risk population. Thus, one of the main questions regarding the clinical validity of at-risk criteria is still unanswered, i.e., whether the at-risk criteria reflect behaviours so common among adolescents and young adults that a valid distinction between ill and non-ill persons is difficult. Based on findings of epidemiological studies of psychosis-like experiences (PLEs), it has been argued, however, that at-risk criteria might indeed be common, non-pathologic phenomena. Yet, PLEs only partially - if at all - resemble at-risk criteria of psychosis. Working hypothesis and specific aims: The aims of this study are to assess (1) the 3-month prevalence of persons fulfilling at least one at-risk criterion in the general population (GP, age segment with greatest risk of psychoses, i.e., age 16 to 40), (2) their co-morbidity, psychosocial functioning and quality of life (QoL), and (3) rate and predictors of help-seeking in participants with at-risk criteria. Drawing on results of a study reporting prevalence rates of subthreshold PLEs resembling APS and own data on the 6-month prevalence of basic symptoms in a smaller GP adolescent sample, the main working hypothesis is to find a prevalence rate of ‘at least one at-risk criterion’ of 9% at most. A 2% deviation from this prevalence will be detectable with a 95% power at a=5%. The potential predictors of help-seeking are number and severity of at-risk symptoms, sociodemographic variables, axis-I co-morbidity, psychosocial functioning, QoL and current somatic health; their predictive accuracy will be assessed by multivariate logistic regression analysis.Methods: A random GP sample of the Canton Bern stratified by urbanisation, age and gender will be recruited. We expect a rate of persons with valid phone numbers of 80% and, of these, a response rate of 70%, consisting of 95% fulfilling the inclusion criteria and 5% fulfilling the exclusion criteria (life-time diagnosis of psychosis or insufficient language skills in German, English or French). Based on the calculated target sample size of 2’750 for the main hypothesis, a random sample of 5’170 contact details will be provided by the Agency for Informatics and Organisation of the Canton Bern (KAIO). Information letters will be sent to potential participants. Within 4 weeks, people will be contacted and interviewed by phone supported by ‘Computer Assisted Telephone Interviewing’ (CATI). Assessments as well as interviewing techniques will be extensively trained before the study. A lottery incentive will be used to increase response rate.Feasibility studies: The first feasibility of this design has been empirically tested by the applicants in the Canton Bern in August/September 2009 (N=102). Beside an appropriate response rate of 70%, the information letter and the incentive (lottery) were well received. Most importantly, no participant felt uncomfortable with the questions or was distressed by the interview. Furthermore, all participants signalled willingness to participate in future similar studies or follow-ups. A second feasibility study of the validity of telephone-assessed symptoms (N=40) showed that the assessment of at-risk criteria on the telephone and in face-to-face interviews lead to comparable results.Expected value: Early detection of psychoses is already widely applied in clinical and research settings both in Switzerland as well as internationally. The findings of this study will be of high value for the development of future early detection strategies. (1) If at-risk criteria at population level were rather frequent phenomena of no clinical significance (i.e., not associated with co-morbid mental disorders, poor social functioning and QoL), screening procedures based on these criteria but also awareness and information campaigns might do more harm than good by pathologising non-clinical experiences and, consequently, by bringing persons into (potentially harmful) treatment who would not have sought help without these screenings or campaigns. In this case, at-risk criteria have to be improved, e.g., by the inclusion of severe distress or disability as an obligatory criterion. (2) On the other hand, if the prevalence of at-risk criteria was low and their presence distressing or disabling, encouraging help-seeking would be mandatory. Thereby, knowledge of variables facilitating and hindering help-seeking is important for the development of awareness and information campaigns. Yet, one way or the other, persons at risk of developing psychosis will greatly profit from the results of this study.