19 March 2019

Testing times: finding new ways of identifying those at risk of severe mental illness

Testing times: finding new ways of identifying those at risk of severe mental illness

Mental illness is the number one challenge facing Australia’s young people, with one in four experiencing mental ill-health each year. One of the urgent challenges is to create a simpler and more effective approach to early identification and treatment of emerging mental disorders in young people in order to improve their mental health outcomes.

The Clinical High At Risk Mental State (CHARMS) study seeks to test a new set of clinical criteria to identify help-seeking young people who are at risk of progressing to a severe mental illness. The criteria are based on symptoms of moderate intensity and family history of mental illness.

The CHARMS study is an attempt to broaden the highly successful ultra-high risk (UHR) approach to identifying psychosis risk in young people. The UHR method, pioneered at Orygen, involves early detection of those at risk of developing schizophrenia and other psychotic disorders so that preventive treatments can be implemented and causes can be better understood.

Professor Barnaby Nelson, lead researcher on CHARMS, said the study was trialling how to broaden the scope of the UHR criteria to pick up on risk for a range of disorders, not only psychosis, but also bipolar disorder, severe major depressive disorder and borderline personality disorder.

“Many young people present to services with a number of co-existing symptoms of mental ill-health,” Professor Nelson said.

 “What we’re trying to do is to detect help-seeking young people at risk of progressing to a serious mental disorder transdiagnostically, that is, to identify those who might be at risk of a range of different disorders rather than a single specific disorder.

“We know that there are many pathways into specific disorders and also that different serious mental disorders have common risk factors and early signs, so we’re trying to capitalise on that by having a broad, inclusive identification approach.

“We’re looking at the full picture and seeing how all these early symptoms might relate to each other, how they might influence each other over time, and also trying to figure out which risk factors might be quite specific to particular disorders and which ones might be associated with more general risk for serious mental disorder.”

These are the first steps. If the CHARMS identification approach proves to be useful then it introduces the possibility of trialling preventive treatments for this broad at-risk group, Professor Nelson said.