This presentation shows the results of screening a help-seeking population for the ultrahigh risk to develop psychosis or other psychiatric disorders

1. The detection of Ultra High Risk patients in a help-seeking population: first data from EDIE.NL Magic tricks with epidemiology: finding the needle in the haystack May 6 th 2010 Edinburgh, Scotland Mark van der Gaag

5. The base rate problem General population: 17% positive on test Incidence is 2 per 10.000 each year Level 3: 20% positive on test Incidence is 10 % each year Positive predictive value = 0.06 % Positive predictive value = 25 % False positive = unnecessary treatment 14-05-2009 Test pos Test neg Psychosis 1 1 No psych 1699 8299 Test pos Test neg Psychosis 500 500 No psych 1500 7500

6. Prevalence subclinical symptoms

7. NEMESIS: evidence for psychologal factors in the final pathway to psychosis Outcome at 3 years follow-up N=7076: 18.1% PLEs 84% remission 8% PLE 8% PSY Negative appraisal of PLEs  psychosis Hanssen, 2005 Hallucinations + negative appraisal  psychosis Krabbendam, 2004

8. Combination of axis 1 disorder plus ARMS

9. Sackett, Haynes, Guyatt and Tugwell 1991

11. Persistence of UHR by exposure to trauma, cannabis and urbanisation Cougnard, 2007

12. ARMS in secondary mental health? SZ Psychosis Level 3: PLE with distress, help-seeking, co-morbidity, decline in functioning Level 2: other psychiatric syndromes, sporadic PLE Level 1: PLE, no distress, no help-seeking, no decline in functioning Level 0: no psychotic-like experiences Yung, 2006 Wanted

17. Comorbid disorders of UHR

19. Sensitivity en specificity of PQ at the gold standard CAARMS ARMS plus Psychosis

22. Thank you for your attention Mark van der Gaag [email_address]