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Evaluating the tendencies of community practitioners who actively practice in child and adolescent psychiatry to diagnose and treat DSM-5 attenuated psychotic syndrome

Research output: Contribution to journalArticlepeer-review

Helin Yilmaz Kafali, Mireia Solerdelcoll, Lena Vujinovic, Dmytro Martsenkovskyi, Sewanu Awhangansi, Camille Noel, Emre Bora, Celso Arango

Original languageEnglish
Pages (from-to)1635-1644
Number of pages10
JournalEuropean Child and Adolescent Psychiatry
Issue number10
Early online date20 Oct 2021
Accepted/In press13 Oct 2021
E-pub ahead of print20 Oct 2021
PublishedOct 2022

Bibliographical note

Funding Information: Dr. Solerdelcoll receives grant support from the Alicia Koplowitz Foundation. Dr Arango has been supported by the Spanish Ministry of Science and Innovation. Instituto de Salud Carlos III (SAM16PE07CP1, PI16/02012, PI19/024), co-financed by ERDF Funds from the EuropeanCommission, “A way of making Europe”, CIBERSAM. Madrid Regional Government (B2017/BMD-3740 AGES-CM-2), European Union Structural Funds. European Union Seventh Framework Program under grant agreements FP7-4-HEALTH-2009-2.2.1-2-241909 (Project EU-GEI), FP7- HEALTH-2013-2.2.1-2-603196 (Project PSYSCAN) and FP7-HEALTH-2013-2.2.1-2-602478 (Project METSY); and European Union H2020 Program under the Innovative Medicines Initiative 2 Joint Undertaking (grant agreement No 115916, Project PRISM, and grant agreement No 777394, Project AIMS-2-TRIALS), Fundación Familia Alonso and Fundación Alicia Koplowitz. The authors declare that they have no potential conflicts of interest in relation to this article. Publisher Copyright: © 2021, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.

King's Authors


The detection of individuals at clinical ultra-high risk for psychosis (CHR-P) may be a key limiting step for early interventions, and there is some uncertainty regarding the true clinical reliability of the CHR-P states. The aim of this study was to explore how practitioners who were in the direct treatment of children with psychiatric disorders [child psychiatry specialists/trainees (n = 227, n = 131), adult psychiatrists (n = 27), and child neurologists (n = 2)] perceive the DSM-5-Attenuated Psychosis Syndrome (DSM-5-APS), and their clinical routine practice in the treatment of it. Three vignettes describing fictional cases presented with symptoms of either DSM-5-Schizophrenia, DSM-5-APS, and no psychotic symptoms were created. We asked these practitioners to apply a DSM-5 diagnosis and to choose appropriate treatment(s) for these vignettes. Of the responders, 43% correctly diagnosed the APS vignette, whereas 37.4% mentioned that it had a full-blown psychotic episode. Regarding the therapeutic approach for the APS vignette, 72.1% of all practitioners chose a psychopharmacological intervention and 32% individual psychotherapy. This study showed that the diagnostic inter-rater reliability of the DSM-5-APS among child/adolescent mental health practitioners was consistent with the results from the DSM-5 field trials (Kappa = 0.46). Moreover, almost three in four practitioners endorsed psychopharmacological intervention as a treatment option for the DSM-5-APS case. The lack of evidence of psychopharmacological interventions in CHR-P situations emphasizes that the least harmful interventions should be recommended. Thus, our findings indicated a need for raising awareness regarding the CHR-P paradigm and its treatment as well as the development of solid guidelines that can be implemented in clinical practice.

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