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The CAARMS - Coggle Diagram

- - - - State: 30% drop or <50 SOFAS score (functioning)
      - Trait: family history
      - Deterioration within last year, sustained for 1+ months, < 5 years
  - - - Symptoms e.g. overvalued ideas, perceptual distortions
      - For 1+ week, < 5 years
      - Frequency: at least 1x+/month to 2x/week for > 1 hr or 3-6x/week for < 1hr
      - Recency: past year
      - Functioning: 30% drop or <50 SOFAS score
    - - Symptoms: e.g. full delusions, hallucinations
      - Frequency: up to 1x/month-2x/week for > 1 hr or 3-6x/week for < 1hr
      - Duration: 1+ week, < 5 years
      - Recency: past year
      - Functioning: 30% drop or <50 SOFAS score
  - - - Ask family member for collateral history, as client may have memory issues that impede knowing how long the episode was
  - - - Severity = attenuated range
      - Frequency = 3-6
    - - Severity = psychotic range
      - Frequency = 3
    - - Severity = psychotic range
      - Frequency = 4-6 but max 1 week
- - - - Ask additional questions to clarify
  - - - Primary anchors = bold, used primarily
      - If unsure, use the higher rating
    - - Substance use association (0-2)
        
        no relation, occurs during or outside peak intoxication of any substance, occurs only during peak intoxication of cannabis or alcohol
      - Don't rate if during peak intoxication with substance that produces psychotic experiences, e.g. LSD
    - - In BLIPS, offset = not psychotic any more
    - - "times per week" = days per week
      - "occasion" = day
    - - Score the one that meets criteria for psychosis etc (see ppt for decision tree)
    - - Set onset as when reached max severity in the last 12 months
    - - Can ask what family/friends think of the idea
  - - - because of e.g. paranoia or didn't come voluntarily
    - - because wants help, so inflating reports
      - dig into detail with questions
      - could have personality disorder they need help with
      - Workaround: tell them you have to ask everyone these questions
- - - - I.e. prodromal phase
      - Other tools = SIPS and SOPS (US)
      - ARMS, UHR, CHR, CHRP - all mean at risk
      - But does it?
        
        Initial validity (Yung et al., 2005)
        
        In 49 UHR young people
        
        CAARMS score associated with risk of transition
        
        -ve symptoms more predictive than +ve
        
        [so odd that OASIS concentrates on the +ve subscale]
        
        Discriminant validity: symptoms more common in UHR than gen pop
        
        Established concurrent validity, predictive validity and inter-rated reliability
        
        Prognostic significance (Fusar-Poli et al., 2017)
        
        BLIPS people 0.54 5-year risk of psychosis
        
        Particularly high risk if recurrent BLIPS (rare)
        
        Seriously disorganising/dangerous features = extremely high risk (0.89 risk in 5 years)
        
        Potentially because these features mean they're already at the psychotic threshold
        
        It's a matter of definition whether someone with BLIPS and these features at baseline has already crossed the threshold
        
        Meta-analysis of predictive accuracy (Oliver et al. (2020)
        
        Only acceptable not outstanding
        Poor specificity
        
        Negative symptoms might be more predictive
        
        Velthorst et al., 2009 for SIPS and other measures
        
        Yung et al. 2005
    - - Though ICD/CAARMS don't agree in BLIPS (Fusar-Poli et al. 2017)
        
        Rest met other ICD diagnosis criteria
        
        68% met ICD-10 criteria for Acute and Transient Psychotic Disorder
    - - EIP may not be the top-priority service for them
- - - - Delusional mood and perplexity
        
        Something odd going on, not sure what
        
        If perplexed about something rated elsewhere, don't repeat the rating here
      - Ideas of reference
        
        Things/self have special meaning/significance
      - Bizarre ideas
        
        Thought control, insertion, withdrawal, broadcasting, mind reading
        
        Impossible, not just improbable
      - Not related to persecutory experiences
      - Global rating scale
        
        0-2 = normal
        
        3-5 = attenuated
        
        6 = psychotic
        
        Original, highly improbable thoughts held with complete conviction
    - - Suspiciousness, persecutory ideas
      - Gradiose ideas
      - Somatic ideas
        
        Believes body has changed in appearance or function
      - Ideas of Guilt
      - Nihilistic Ideas
        
        World/self was not real, does not exist or is dead
      - Jealous ideas
      - Religious ideas
        
        Preoccupation with religious themes/unusual religious experiences
      - Erotomanic ideas
        
        False ideas and feelings about relationship that may not exist
      - Global rating scale
        
        0-2 = normal
        
        3-5 = attenuated - logical evidence decreases as score increases
        
        6 = psychotic
        
        Original, highly improbable thoughts held with complete conviction
      - Tips for rating
        
        If unsure whether experiences real, ask friends and family
        
        If ideas of reference within paranoia, rate here, not UTC
        
        Delusional explantion of unusual experience (e.g. hallucination) is rated separately here and in e.g. perceptual abnormalities
        
        To distinguish them, social anxiety = threat = internal, whereas suspiciousness = threat = external
        
        Benevolent experiences related to persecution (e.g. warning messages) rated here
    - - Direct sensation that is visual, auditory, olfactory, gustatory, tactile or somatic
      - Somatic changes need to be perceived physically, not just an idea (so not in 'somatic ideas' of 'non-bizarre ideas')
      - Global rating scale
        
        0-2 = normal
        
        up to experiencing distortions and illusions, non-distressing
        
        3-4 = attenuated
        
        up to hearing things, but transient and give plausible explanation
        
        5-6 = psychotic
        
        Hallucinations, may be able to question them with effort
      - Tips for rating
        
        Rate voice on whether it's an actual voice, not on whether internal or external
        
        Difference between 4 and 5 = "true hallucination" - quality of real perception
        
        So ask them to give a detailed description
        
        Score secondary delusions about perceptual distortions under UTC or NBIs
    - - Subjective change
        
        Own report of difficulties with speech and communication
      - Objective rating
        
        Observed by clinician
        
        Score > 2 relies on this
      - Global rating scale
        
        0-3= normal
        
        Up to somewhat vague, circumstantial, irrelevant
        
        3-5 = attenuated
        
        Up to marked circumstantiality or tangentiality but responds to structuring
        
        6 = psychotic
        
        Continuous disorganisation in the interview: incoherent, unintelligible, significant difficulty following line of thought