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Verlauf von und Belastung durch Risikosymptome und -kriterien in der Allgemeinbevölkerung: 3-Jahres Nachuntersuchung der Bern Epidemiological At-Risk (BEAR) Studie

English title Course and burden of risk symptoms and criteria of psychosis in the community: 3 -year follow-up of the Bern Epidemiological At-Risk (BEAR) study
Applicant Schultze-Lutter Frauke
Number 155951
Funding scheme Project funding (Div. I-III)
Research institution Universitätsklinik für Kinder- und Jugendpsychiatrie und Psychotherapie Universitäre Psychiatrische Dienste Bern
Institution of higher education University of Berne - BE
Main discipline Methods of Epidemiology and Preventive Medicine
Start/End 01.06.2015 - 31.03.2018
Approved amount 180'000.00
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All Disciplines (2)

Discipline
Methods of Epidemiology and Preventive Medicine
Mental Disorders, Psychosomatic Diseases

Keywords (6)

Epidemiology; At-Risk Mental State; Early Detection; Psychosis; Mental Disorders; Pathway to care

Lay Summary (German)

Lead
Psychosen zählen nach ihrer Erstmanifestation zu den schwerwiegendsten Erkrankungen, weshalb ihre Prävention als erfolgversprechendste Strategie angesehen wird. Zwei Früherkennungsansätze haben sich in hilfesuchenden Patientengruppen bereits bewährt. Ihr langfristiger klinischer Stellenwert in der Allgemeinbevölkerung ist jedoch unklar und Ziel des Projekts.
Lay summary

Inhalt und Ziele des Forschungsprojekts

Trotz aller Therapiefortschritte und einer Lebenszeitprävalenz von nur 3,5% sind Psychosen nach ihrem ersten Ausbruch noch immer eine der Erkrankungen mit den höchsten Belastungen, weshalb die Vermeidung ihres Ausbruchs bei gefährdeten Personen vorrangig erscheint. Hierzu wurden in Patientengruppen bereits zwei Früherkennungsansätze entwickelt: ultra-high risk und Basissymptomkriterien. Unserer erste Projektphase zeigte bereits, dass hierin enthaltene Risikosymptome zwar von etwa 25% der 16- bis 40-jährigen Allgemeinbevölkerung des Kantons Bern berichtet werden, jedoch nur bei etwa 3% ausgeprägt genug sind, um den Risikokriterien zu genügen.

Ihr Verlauf und Zusammenhang mit psychotischen und anderen psychischen Erkrankungen in der Allgemeinbevölkerung sollen nun erstmals in der zweiten Projektphase untersucht werden. Hierbei sollen 500 Personen, die in der ersten Phase berichtet hatten, jemals irgendein Risikosymptom bemerkt zu haben, sowie 500 Kontrollpersonen vergleichbaren Alters und Geschlechts nach 3 Jahren erneut auf Risikosymptome und psychische Störungen hin untersucht werden.

Wissenschaftlicher und gesellschaftlicher Kontext des Forschungsprojekts

Die Ergebnisse werden erstmals eine Einschätzung des klinischen Stellenwertes heutiger Früherkennungskriterien und des angemessenen Umgangs mit diesen in vorpsychiatrischen Einrichtungen (etwa Hausarztpraxen) erlauben.

Direct link to Lay Summary Last update: 14.04.2015

Responsible applicant and co-applicants

Employees

Collaboration

Group / person Country
Types of collaboration
Institut für Sozial- und Präventivmedizin der Universität Bern, Abteilung für Gesundheitsforschung Switzerland (Europe)
- Research Infrastructure

Scientific events

Active participation

Title Type of contribution Title of article or contribution Date Place Persons involved
26th European Congress of Psychiatry Talk given at a conference Indicated prevention in psychosis: Developmental aspects 03.03.2018 Nizza, France Schultze-Lutter Frauke;
WPA XVII World Congress of Psychiatry Talk given at a conference Prediction of Psychoses: State-of-the-art & future perspectives 08.10.2017 Berlin, Germany Schultze-Lutter Frauke;
17th International ESCAP Congress Talk given at a conference Identification of clinical high risk of psychoses: special requirements in children and adolescents 09.07.2017 Genf, Switzerland Schultze-Lutter Frauke;
10th IEPA conference Poster What becomes of risk symptoms in the community? 2.5-year follow-up findings of the Bern Epidemiological At-Risk (BEAR) study. 20.10.2016 Tokyo, Japan Schultze-Lutter Frauke;
5th European Conference on Schizophrenia Research Talk given at a conference Follow-up findings of the Bern Epidemiological At-Risk (BEAR) study 23.09.2015 Berlin, Germany Schultze-Lutter Frauke;
5th European Conference on Schizophrenia Research Poster Clinical high risk symptoms and criteria in the community: Prevalence, clinical significance and risk factors for their occurrence 23.09.2015 Berlin, Germany Schultze-Lutter Frauke;


Associated projects

Number Title Start Funding scheme
144100 Früherkennung von Psychosen im Kindes- und Jugendalter: Evaluation der Risikokriterien 01.09.2013 Project funding (Div. I-III)

Abstract

Background: An indicated prevention of psychosis is currently regarded the most promising strategy to reduce the enormous disability and costs of this disease. To this, 2 complementary sets of risk criteria are currently used: ‘ultra high risk’ (UHR) criteria including attenuated psychotic symptoms (APS) and basic symptom criteria. To date, longitudinal prevention research in psychosis has only been carried out in selected samples of help-seeking risk persons that must be assumed a non-representative minority of the at-risk population. In these samples, higher rates of subsequent psychosis and other non-psychotic severe mental disorders and lower long-term functioning but also high remission rates of risk symptoms/criteria have been observed. Based on these observations, an Attenuated Psychosis Syndrome adapted from the APS-UHR criterion is discussed as a new self-contained disorder but not a risk syndrome for inclusion in the main text of a revision of DSM-5. Yet, only a study on the natural course of risk symptoms/criteria in the community assessed in the same way as in the clinic will inform whether these should be considered as: (a) a self-contained disorder similar to the Attenuated Psychosis Syndrome, (b) general risk indicators of future severe mental disorders, (c) specific risk indicators of future psychosis, or (d) non-pathological variations in mental state.Working hypothesis and specific aims: The main aim of this study is to assess the 3-year outcome of persons who had reported risk symptoms/criteria (RISK) in comparison to persons who had not reported risk symptoms at baseline (CONTROL); we expect the development of more psychotic and also of more non-psychotic axis-I disorders as well as a lower functioning in RISK. After adjusting for multiple testing, already small group differences will be detectable with a minimum power of 95%. Further aims are to examine (1) the rate and clinical significance of persistent risk symptoms (i.e., their relation to functioning, mental disorders, need for care and life satisfaction), (2) predictors of persistence, (3), predictors of first help-seeking for mental problems within the follow-up period, and (4) the rate and predictors of new occurrence of risk symptoms and criteria in CONTROL. Potential predictors studied in addition to risk symptoms/criteria and outcome measures are sociodemographic variables, help-seeking and offered help, life satisfaction, psychiatric “caseness” / need for care and somatic health; their predictive accuracy will be assessed by multivariate logistic regression analysis.Methods: In the BEAR study, a random 16- to 40-year-old community sample of the Canton Bern (N=2’682) was interviewed by phone for risk symptoms and criteria, after the reliability of phone interviews in comparison to face-to-face interviews had been assured. A quarter of participants had reported risk symptoms (RISK) with less than 3% meeting risk criteria, they were not informed about the “result”; 97.5% of all participants agreed to be re-contacted for a potential follow-up. Expecting a low refusal rate (5%) and an ineligibility rate of 20% (deceased, invalid address or phone number, staying abroad or >100 unanswered calls), 500 RISK and 500 age- and gender-matched CONTROL will be re-assessed. Information letters will be sent to potential participants, and contact will be re-established within 4 weeks supported by ‘Computer Assisted Telephone Interviewing’ (CATI). Assessments will be carried out by an experienced interviewer of the baseline study.Feasibility study: A 2.5-year follow-up of 150 participants in the baseline assessment who had agreed to re-contacting demonstrated a high response rate (99% of the 102 with re-established contact and decision about participation) with a refusal rate of less than 5% (n=1). Main reason for non-participation will be ineligibility, expected at 20%. Again, no participant felt uncomfortable or distressed with the questions or was unwilling to be re-contacted for a potential second follow-up.Expected value: Early detection of psychoses is already widely applied in clinical and research settings both in Switzerland and world-wide. The follow-up findings will advice future clinical and research strategies as follows: (1) If risk symptoms/criteria at population level indicate a substantially increased risk for developing a psychotic or other severe mental disorder, help-seeking should be encouraged. Thereby, knowledge of variables predicting and/or hindering help-seeking is important for the development of awareness and information campaigns. (2) Yet, even if risk symptoms/criteria do not herald severe mental disorders in the community but are rather persistent phenomena of clinical significance, considering them as a self-contained disorder should be promoted. (3) On the other hand, if risk symptoms/criteria and associated problems frequently remit spontaneously, screenings but also awareness and information campaigns based on these might in fact do more harm than good by pathologising non-clinical experiences. In this case, variables enhancing their clinical significance in help-seeking samples and their role in predicting psychosis, mental disorder and/or lower functioning should be explored.Thus the anticipated findings will be of immense value in the development of effective preventive services on national and international level; and will inform pending decisions on if and where to position the Attenuated Psychosis Syndrome in DSM-5.1.
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