Half of adults who develop  schizophrenia had attended CAMHS services 

Half of adults who develop  schizophrenia had attended CAMHS services 

Schizophrenia and bipolar disorder affect about 65m people worldwide and are usually diagnosed in early to mid adulthood.

Breakthrough research involving a team from University College Dublin has found that half of people who developed schizophrenia or bipolar disorder as an adult had attended Child and Adolescent Mental Health Services (CAMHS), sparking hopes that more earlier intervention could prevent or predict such conditions later in life.

The research paper looks at data from the CAMHS in Finland, with lead author Dr Ian Kelleher, Consultant Child and Adolescent Psychiatrist and Associate Professor at the UCD School of Medicine, admitting that the results were "contrary to expectations".

"Schizophrenia and bipolar disorder affect about 65m people worldwide and are usually diagnosed in early to mid adulthood. The conditions are associated with huge disability, personal and societal cost. 

"We would like to be able to prevent these illnesses but we haven't been very successful to date at identifying individuals who are at risk of psychosis (so we know who we can intervene with).

According to the study: "Current strategies to predict psychosis identify only a small proportion of individuals at risk. 

"Additional strategies are needed to increase capacity for prediction and prevention of serious mental illness, ideally during childhood and adolescence."

One possible approach would be to investigate systems in which psychosis risk factors are concentrated during childhood.

Researchers used population data relating to Finns born since 1987 and then analysed other databases, including attendance at CAMHS at some point in their lives and a diagnosis of schizophrenia or bipolar by the age of 28.

"Of all diagnoses of any psychosis or bipolar disorder by age 28 years, 50.2% occurred among individuals who had attended CAMHS during childhood or adolescence," it said.

It also found that "compared to other CAMHS attendees, individuals who developed psychosis or bipolar disorder were more likely to have had an initial CAMHS diagnosis of depressive or other mood disorder and disruptive behaviour disorder, and less likely to have been diagnosed with neurodevelopmental disorders".

"Just 16.6% of these psychosis or bipolar disorder cases were diagnosed within three months of first attending outpatient CAMHS or on first inpatient CAMHS admission," it said.

"For the remaining 83.4%, the median time from first CAMHS contact to psychosis or bipolar diagnosis was more than six years years. 

Untapped potential for prediction of psychosis

"Overall, these findings highlight an enormous untapped potential for prediction of psychosis and bipolar disorder within already existing specialist paediatric mental health services.

"First, and fundamentally, our findings show that specialist CAMHS represent a high-capacity system for future psychosis and bipolar disorder prediction research.

"Beyond that, our findings provide guidance on optimal strategies for different types of psychosis and bipolar disorder prediction and prevention research.

"Our findings suggest that children and adolescents attending specialist CAMHS can be an important target in developmental research on psychosis and bipolar disorder aetiology, given the high incidence of these illness outcomes in this population and considering that the median time to diagnosis from first CAMHS contact is more than six years. 

"Identifying pathways to psychosis-related brain abnormalities will, in turn, lead to further opportunities for treatment research.

"Our findings also highlight the importance of transition between adolescent and adult mental health services. 

"The reasons for presenting to CAMHS differ from those for presenting to adult mental health services, and only a small minority of CAMHS patients are subsequently referred to the latter services. 

"Even in cases where onward referral occurs, transition is often associated with poor planning, disrupted care and very high non-attendance or once-off attendance only."

Our findings highlight the importance of a careful coordination of the above transition.

The study also involved Finnish researchers and Dr Kelleher said the lack of a similar electronic health register in Ireland meant a similar analysis could not be carried out here.

However, he said the findings were relevant to any country.

"We know that early intervention is key to improving outcomes in people with mental illness, the reality for people with sever mental illness like schizophrenia is by the time they are diagnosed they are quite far along that path," Dr Kelleher said.

"So they are coming to us in clinical services like CAMHS, so we can intervene earlier.

"We need to do more research about how to prevent the illnesses but if we can reduce the period of illness before the diagnosis, the outcomes are far better."

He said Finland had far higher investment in mental health services than Ireland and "we have to learn, as we always do, from other countries".

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