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Cited by 75Schizophrenia research and treatmentMental Health and PsychiatryMental Health Treatment and Access

Toward a world consensus on prevention of schizophrenia

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Van Os, Jim, Delespaul, Philippe·2005·Dialogues in Clinical Neuroscience
DOI 10.31887/dcns.2005.7.1/jvanosPMC PMC3181724
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Abstract

Screening for preschizophrenia in the general population with the aim of preventing transition to full-blown illness is an epidemiological impossibility because a rare disease cannot be predicted. The lack of specificity resulting in abundance of false-positives can be remedied in part by using much more restrictive screening criteria that combine several indicators of risk for transition to schizophrenia. Raising the specificity (reducing the false-positives), however, can only be done at the expense of sensitivity (increasing the false-negatives). The most commonly used strategy to raise specificity is the sample enrichment strategy. This involves the creation of samples enriched with schizophrenia risk by selectively filtering at-risk people out over a range of consecutive referral processes starting in the general population, through to general practioners, mental health services, and the early detection clinic. However, improvements in specificity obtained by the sample enrichment strategy should not be attributed to the use of some predictive instrument that supposedly identifies high-risk individuals. The epidemiologically and ethically most viable way for screening and early detection is to selectively increase the permeability of the filters on the pathway to mental health care. This will occasion samples of help-seekers enriched with schizophrenia risk at the level of mental health services (thus reducing false-positives), while at the same time making an attempt to "attract" as many detectable schizophrenia prodromes as possible through the filters along the pathway to mental health care (thus reducing false-negatives). Early psychosis research has yielded some useful suggestions in that it is becoming increasingly clear that it is not just psychosis itself, but rather the clinical context of the psychotic experience that determines risk for transition to schizophrenia. Thus, risk for transition to full-blown psychotic disorder is to a large degree determined by size of psychosis "load," comorbid distress and depression, cannabis use, cognitive ability, and subjective reports of impairment and coping. Making a diagnosis of psychotic disorder is not an exact science: it involves an arbitrary cutoff imposed on dimensional variation of psychopathology and need for care over time. Gaining insight into the cognitive and biological factors that drive the dimensional variation, including therapeutic interventions, is arguably more useful than sterile dichotomous prediction models.

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  • The high positive predictive values reported by some studies for transition from ARMS to clinical psychosis are a result of sample enrichment from mainstream sample selection procedures, leading to spuriously increased incidence and predictive values.

    “Further, van Os (2005) highlighted that the high positive predictive values presented by some studies when predicting the transition from the ARMS phase to clinical psychosis (Miller et al., 2002;Yung et al., 2003) are actually an outcome of the sample enrichment that results from the mainstream sample selection procedures.This in turn leads to spuriously increased incidence and predictive values”

    From ‘At risk mental state’ clinics for psychosis – an idea whose time has come – and gone! (2019) · cites this paper as van Os, 2005

  • When the transition rate was estimated based on the actual prevalence of ARMS in the general population, it was shown to be around 1%.

    “In fact, when the transition rate was estimated based on the actual prevalence of the ARMS in the general population it was shown to be around 1% (van Os, 2005).”

    From ‘At risk mental state’ clinics for psychosis – an idea whose time has come – and gone! (2019) · cites this paper as van Os, 2005

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Research works printed but not linked: 1

  1. [68]Rose G. The Strategy of Prevention. Oxford, UK: Oxford Medical Publications 1992

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Authors
Van Os, J., & Delespaul, P.
Affiliations
  • Department of Psychiatry and Neuropsychology, South Limburg Mental Health Research and Teaching Network, European Graduate School of Neuroscience, Maastricht University, The Netherlands; Division of Psychological Medicine, Institute of Psychiatry, London, UK
  • Maastricht University (NL)
ORCID
Delespaul, Philippe
Venue
Dialogues in Clinical Neuroscience
Publisher
Informa UK Limited
Published
2005-03-31
Volume
7
Issue
1
Pages
53-67
ISSN
  • 1294-8322 (ISSN-L)
  • 1958-5969
DOI
10.31887/dcns.2005.7.1/jvanos
PMC
PMC3181724
OpenAlex
W1542528342
Cited by
75
References
76
Citations by year
2024: 2 · 2022: 1 · 2021: 1 · 2020: 2 · 2019: 2 · 2018: 5 · 2017: 2 · 2016: 2 · 2015: 1 · 2013: 6 · 2012: 7
FWCI
1.80
Type
journal article
Language
en
Open access
Licence
Locations
  • Dialogues in Clinical Neuroscience (publishedVersion, cc-by-nc-nd)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
  • Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
Keywords
schizophrenia prevention, early psychosis, false-positive screening results, early detection, help-seeking pathways, dimensional models of psychopathology, cannabis use, comorbid depression, cognitive ability
MeSH terms
Humans, Psychotic Disorders, Risk Factors, Schizophrenia, Global Health

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