Pluripotential Risk and Clinical Staging: Theoretical Considerations and Preliminary Data From a Transdiagnostic Risk Identification Approach

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...
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Autor*in:	Jessica A. Hartmann [verfasserIn] Patrick D. McGorry [verfasserIn] Louise Destree [verfasserIn] G. Paul Amminger [verfasserIn] Andrew M. Chanen [verfasserIn] Christopher G. Davey [verfasserIn] Rachid Ghieh [verfasserIn] Andrea Polari [verfasserIn] Aswin Ratheesh [verfasserIn] Hok Pan Yuen [verfasserIn] Barnaby Nelson [verfasserIn]

Format:	E-Artikel
Sprache:	Englisch

Erschienen:	2021

Schlagwörter:	at-risk (youth) transdiagnostic pluripotency clinical staging model at risk mental state

Übergeordnetes Werk:	In: Frontiers in Psychiatry - Frontiers Media S.A., 2010, 11(2021)
Übergeordnetes Werk:	volume:11 ; year:2021

Links:	Link aufrufen Link aufrufen Link aufrufen Journal toc

DOI / URN:	10.3389/fpsyt.2020.553578

Katalog-ID:	DOAJ055336493

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allfields_unstemmed	10.3389/fpsyt.2020.553578 doi (DE-627)DOAJ055336493 (DE-599)DOAJ0bec6f62c7fa4484af9a98e92fdabf69 DE-627 ger DE-627 rakwb eng RC435-571 Jessica A. Hartmann verfasserin aut Pluripotential Risk and Clinical Staging: Theoretical Considerations and Preliminary Data From a Transdiagnostic Risk Identification Approach 2021 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier 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. at-risk (youth) transdiagnostic pluripotency clinical staging model at risk mental state Psychiatry Jessica A. Hartmann verfasserin aut Patrick D. McGorry verfasserin aut Patrick D. McGorry verfasserin aut Louise Destree verfasserin aut G. Paul Amminger verfasserin aut G. Paul Amminger verfasserin aut Andrew M. Chanen verfasserin aut Andrew M. Chanen verfasserin aut Christopher G. Davey verfasserin aut Christopher G. Davey verfasserin aut Christopher G. Davey verfasserin aut Rachid Ghieh verfasserin aut Rachid Ghieh verfasserin aut Andrea Polari verfasserin aut Andrea Polari verfasserin aut Aswin Ratheesh verfasserin aut Aswin Ratheesh verfasserin aut Hok Pan Yuen verfasserin aut Hok Pan Yuen verfasserin aut Barnaby Nelson verfasserin aut Barnaby Nelson verfasserin aut In Frontiers in Psychiatry Frontiers Media S.A., 2010 11(2021) (DE-627)631498796 (DE-600)2564218-2 16640640 nnns volume:11 year:2021 https://doi.org/10.3389/fpsyt.2020.553578 kostenfrei https://doaj.org/article/0bec6f62c7fa4484af9a98e92fdabf69 kostenfrei https://www.frontiersin.org/articles/10.3389/fpsyt.2020.553578/full kostenfrei https://doaj.org/toc/1664-0640 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 11 2021
allfieldsGer	10.3389/fpsyt.2020.553578 doi (DE-627)DOAJ055336493 (DE-599)DOAJ0bec6f62c7fa4484af9a98e92fdabf69 DE-627 ger DE-627 rakwb eng RC435-571 Jessica A. Hartmann verfasserin aut Pluripotential Risk and Clinical Staging: Theoretical Considerations and Preliminary Data From a Transdiagnostic Risk Identification Approach 2021 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier 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. at-risk (youth) transdiagnostic pluripotency clinical staging model at risk mental state Psychiatry Jessica A. Hartmann verfasserin aut Patrick D. McGorry verfasserin aut Patrick D. McGorry verfasserin aut Louise Destree verfasserin aut G. Paul Amminger verfasserin aut G. Paul Amminger verfasserin aut Andrew M. Chanen verfasserin aut Andrew M. Chanen verfasserin aut Christopher G. Davey verfasserin aut Christopher G. Davey verfasserin aut Christopher G. Davey verfasserin aut Rachid Ghieh verfasserin aut Rachid Ghieh verfasserin aut Andrea Polari verfasserin aut Andrea Polari verfasserin aut Aswin Ratheesh verfasserin aut Aswin Ratheesh verfasserin aut Hok Pan Yuen verfasserin aut Hok Pan Yuen verfasserin aut Barnaby Nelson verfasserin aut Barnaby Nelson verfasserin aut In Frontiers in Psychiatry Frontiers Media S.A., 2010 11(2021) (DE-627)631498796 (DE-600)2564218-2 16640640 nnns volume:11 year:2021 https://doi.org/10.3389/fpsyt.2020.553578 kostenfrei https://doaj.org/article/0bec6f62c7fa4484af9a98e92fdabf69 kostenfrei https://www.frontiersin.org/articles/10.3389/fpsyt.2020.553578/full kostenfrei https://doaj.org/toc/1664-0640 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 11 2021
allfieldsSound	10.3389/fpsyt.2020.553578 doi (DE-627)DOAJ055336493 (DE-599)DOAJ0bec6f62c7fa4484af9a98e92fdabf69 DE-627 ger DE-627 rakwb eng RC435-571 Jessica A. Hartmann verfasserin aut Pluripotential Risk and Clinical Staging: Theoretical Considerations and Preliminary Data From a Transdiagnostic Risk Identification Approach 2021 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier 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. at-risk (youth) transdiagnostic pluripotency clinical staging model at risk mental state Psychiatry Jessica A. Hartmann verfasserin aut Patrick D. McGorry verfasserin aut Patrick D. McGorry verfasserin aut Louise Destree verfasserin aut G. Paul Amminger verfasserin aut G. Paul Amminger verfasserin aut Andrew M. Chanen verfasserin aut Andrew M. Chanen verfasserin aut Christopher G. Davey verfasserin aut Christopher G. Davey verfasserin aut Christopher G. Davey verfasserin aut Rachid Ghieh verfasserin aut Rachid Ghieh verfasserin aut Andrea Polari verfasserin aut Andrea Polari verfasserin aut Aswin Ratheesh verfasserin aut Aswin Ratheesh verfasserin aut Hok Pan Yuen verfasserin aut Hok Pan Yuen verfasserin aut Barnaby Nelson verfasserin aut Barnaby Nelson verfasserin aut In Frontiers in Psychiatry Frontiers Media S.A., 2010 11(2021) (DE-627)631498796 (DE-600)2564218-2 16640640 nnns volume:11 year:2021 https://doi.org/10.3389/fpsyt.2020.553578 kostenfrei https://doaj.org/article/0bec6f62c7fa4484af9a98e92fdabf69 kostenfrei https://www.frontiersin.org/articles/10.3389/fpsyt.2020.553578/full kostenfrei https://doaj.org/toc/1664-0640 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 11 2021
language	English
source	In Frontiers in Psychiatry 11(2021) volume:11 year:2021
sourceStr	In Frontiers in Psychiatry 11(2021) volume:11 year:2021
format_phy_str_mv	Article
institution	findex.gbv.de
topic_facet	at-risk (youth) transdiagnostic pluripotency clinical staging model at risk mental state Psychiatry
isfreeaccess_bool	true
container_title	Frontiers in Psychiatry
authorswithroles_txt_mv	Jessica A. Hartmann @@aut@@ Patrick D. McGorry @@aut@@ Louise Destree @@aut@@ G. Paul Amminger @@aut@@ Andrew M. Chanen @@aut@@ Christopher G. Davey @@aut@@ Rachid Ghieh @@aut@@ Andrea Polari @@aut@@ Aswin Ratheesh @@aut@@ Hok Pan Yuen @@aut@@ Barnaby Nelson @@aut@@
publishDateDaySort_date	2021-01-01T00:00:00Z
hierarchy_top_id	631498796
id	DOAJ055336493
language_de	englisch
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callnumber-first	R - Medicine
author	Jessica A. Hartmann
spellingShingle	Jessica A. Hartmann misc RC435-571 misc at-risk (youth) misc transdiagnostic misc pluripotency misc clinical staging model misc at risk mental state misc Psychiatry Pluripotential Risk and Clinical Staging: Theoretical Considerations and Preliminary Data From a Transdiagnostic Risk Identification Approach
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topic_title	RC435-571 Pluripotential Risk and Clinical Staging: Theoretical Considerations and Preliminary Data From a Transdiagnostic Risk Identification Approach at-risk (youth) transdiagnostic pluripotency clinical staging model at risk mental state
topic	misc RC435-571 misc at-risk (youth) misc transdiagnostic misc pluripotency misc clinical staging model misc at risk mental state misc Psychiatry
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title	Pluripotential Risk and Clinical Staging: Theoretical Considerations and Preliminary Data From a Transdiagnostic Risk Identification Approach
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title_full	Pluripotential Risk and Clinical Staging: Theoretical Considerations and Preliminary Data From a Transdiagnostic Risk Identification Approach
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author_browse	Jessica A. Hartmann Patrick D. McGorry Louise Destree G. Paul Amminger Andrew M. Chanen Christopher G. Davey Rachid Ghieh Andrea Polari Aswin Ratheesh Hok Pan Yuen Barnaby Nelson
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title_sort	pluripotential risk and clinical staging: theoretical considerations and preliminary data from a transdiagnostic risk identification approach
callnumber	RC435-571
title_auth	Pluripotential Risk and Clinical Staging: Theoretical Considerations and Preliminary Data From a Transdiagnostic Risk Identification Approach
abstract	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.
abstractGer	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.
abstract_unstemmed	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.
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title_short	Pluripotential Risk and Clinical Staging: Theoretical Considerations and Preliminary Data From a Transdiagnostic Risk Identification Approach
url	https://doi.org/10.3389/fpsyt.2020.553578 https://doaj.org/article/0bec6f62c7fa4484af9a98e92fdabf69 https://www.frontiersin.org/articles/10.3389/fpsyt.2020.553578/full https://doaj.org/toc/1664-0640
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author2	Jessica A. Hartmann Patrick D. McGorry Louise Destree G. Paul Amminger Andrew M. Chanen Christopher G. Davey Rachid Ghieh Andrea Polari Aswin Ratheesh Hok Pan Yuen Barnaby Nelson
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Pluripotential Risk and Clinical Staging: Theoretical Considerations and Preliminary Data From a Transdiagnostic Risk Identification Approach

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