Read Full Text: Sensory characteristics of youth at clinical high risk for psychosis (Not free, because it is so new
But, the topic still seemed important to cover.)
Journal: Early Intervention in Psychiatry
Year Published: 2019
This was a member-requested article! Thank you @Lesa for suggesting it!
During this time of COVID-19, we OTs are doing what we do best: being adaptable. In this case, a global pandemic has us reimagining what our therapy can look like.
It is our hope that the OT Potential Club can help you do that in a proactive way.
Over the past few weeks, weāve been looking at research that highlights new opportunities to reach our patients and improve outcomes.
This weekās article fits well in that theme.
It calls us back to a basic principle: part of our role is to intervene early in the disease process, ideally helping to prevent some of the most worrisome disease symptoms.
This week, we are looking at an article about psychosis which, frankly, is one of the most challenging symptoms that can present with many mental illnesses.
But, thereās good news:
Research indicates that itās possible to identify those at high risk for psychosisāand even reduce the number of people who experience a full-blown episode.
And, in this study, youāll see how an assessment that many OTs are accustomed to administeringāThe Sensory Profileāmay not only help guide early identification of at-risk youth, but also help inform subsequent treatment.
A quick refresher on psychosis
In the simplest sense, psychosis occurs when a person experiences some loss of connection with external reality.
This can present as hallucinations and delusions.
Psychosis is not itself a disease; rather it is a symptom of a broader disease, such as:
- Schizophrenia
- Schizoaffective disorder
- Brief psychotic disorder
- Delusional disorder
- Bipolar psychosis
- Psychotic depression
- Postpartum (also called postnatal) psychosis
- Substance-induced psychosis
The importance of early identification of clinical risk for psychosis
We already know from previous research that identifying psychosis as early as possible is key. Doing so can improve long-term outcomes for our patients.
Historically, this has meant recognizing psychosis as soon as possible once an episode actually starts.
But, there is a growing body of new evidence that shows that high risk for psychosis can be identified PRIOR to the onset episode.
Plus, there are valid and reliable assessments that can categorize people into high-risk and low-risk categories for the possibility of developing psychosis. However, at this point, these assessments are pretty specialized, and not enough patients are being connected with them.
This means the current challenge lies in screening individualsāthen referring them to the right professionals to receive these assessments in the first place. Then, of course, the next hurdle is knowing what to do once high-risk individuals have been identified.
What we already know about sensory differences and psychosis
Sensory differences enter the picture early, during this risk-identification phase. As mentioned above, the nature of psychosis often involves significant alterations to an individualās sensory experience of the worldāand these alterations come in the form of hallucinations and delusions.
Interestingly, research seems to indicate that broader (and more subtle) sensory differences may start to emerge before a patientās first episode of psychosis.
Brain scans of individuals with a high clinical risk of psychosis have shown grey and white matter changes occurring in several different regions of the brainābefore these folks ever have an episode of psychosis!
The findings from the scans seem to suggest that multiple sensory systems are being impacted during this pre-psychosis phase, meaning that broad changes to sensory experiences would be expected. Which leads us to this particular study.
The key research question
The thinking behind this study is this: if we can better understand and quantify these early sensory changes, they may be useful in identifying those at increased risk for psychosis.
The sensory information gathered could also serve the double benefit of helping to guide interventions that aim to prevent (or minimize) the experience of psychosis.
The study started with this question:
Are the sensory characteristics of people at clinically high risk of psychosis different from peers who are at a clinically low risk? (Not to mention, are these sensory characteristics in high-risk individuals different from those seen in the general public?)
How this research study was structured
This study was a cohort design that used data from The Early Detection and Intervention for the Prevention of Psychosis Program (EDIPPP). (A cool research program in its own right!)
This study cross-analyzed data from 205 patients, aged 12-25, who were part of the program. The researchers analyzed scores from:
- The patientsā Adolescent/Adult Sensory Profile
- Normative data from the Adolescent/Adult Sensory Profile
- The Structured Interview for Prodromal Syndrome
- Scale of Prodromal Symptoms (which yielded data to categorize individuals as being clinically high or low risk for psychosis)
The results
Youth who were at clinically high risk for psychosis showed a significantly different pattern of sensory experiences than the general populationāand from those who were at clinically low risk for psychosis.
On the Adolescent/Adult Sensory Profile, these high-risk individuals showed significant variance in 4/4 categories.
They had a significantly higher tendency to self-report behaviors/experiences that signified:
- Low registration
- Sensory sensitivity
- Sensory avoiding
The they were less likely to report:
- Sensory seeking
What the authors concluded/discussed
So, given this distinctive pattern of sensory processing, the authors concluded that sensory differences may, indeed, be a valuable early marker of identifying individuals who are at a high risk of psychosis.
This aligns with previous research that broad sensory changes begin to occur early in the disease process, and prior to a full-blown episode of psychosis.
In my own words, I would say that it seems like the Sensory Profile could essentially be used as a screening tool in the future. Its use could help inform further assessment and intervention to hopefully prevent or minimize full psychosis. (Keep in mind that further study is needed.)
(There is a lot in the discussion that is highly relevant to OTs, so please consider reading the article in its entirety if you work with this population.)
Takeaways for OT practitioners
(These are my personal takeaways, and were not mentioned in the article.)
1. This article feels like part of a larger trend, where the neurological signs OTs have been attentive to are now being confirmed and showing potential in screening.
This article feels extremely similar to another article we reviewed on how soft neurological signs may be effective as an early screen for ADHD.
Soft neurological signs and sensory changes are attractive as possible screens because they are relatively easy to administer, and could be performed by professionals like you!
Screening is a complex topic, so we are still awaiting more guidance from the research on thisābut, in the meantime, if you do work with a patient with this distinctive sensory pattern, it may be worth reaching out to your team to discuss if further assessment is merited.
2. Your skill set is needed. Stay strong in the fight for reimbursement and new models of care.
As is often the case, this articleās findings make me feel like OTs are completely underutilized. From my view of things, research consistently backs up our value, and even pushes me to expand my view of how we could use our skill set.
As the coronavirus is making waves around the globe, the weight of our role in helping people optimize their health feels particularly heavy.
It feels likely that many communities, states, and countries will be reevaluating their investment in healthcare. I hope that research like this makes you feel confident in the importance of our roleāand in our potential to be providing even more assistance to people than our current reimbursement models allow.
Listen to my takeaways in podcast form:
Find platforms for listening to the [OT Potential Podcast here.](https://otpotential.com/ot-potential-podcast)(Possibly) Earn CEUs/PDUs for reading this article.
Many of you can receive continuing education credits for reading this article. Hereās a form to help you do it, along with information to help you understand who qualifies.
And, hereās the full APA citation you many need:
Parham, L. D., Roush, S., Downing, D. T., Michael, P. G., & Mcfarlane, W. R. (2019). Sensory characteristics of youth at clinical high risk for psychosis. Early Intervention in Psychiatry, 13(2), 264ā271. doi: 10.1111/eip.12475
) I will reach out to her!
!