Jessica Hartmann1, Barnaby Nelson1, Rachael Spooner1, G. Paul Amminger1, Andrew Chanen1, Aswin Ratheesh1, Christopher Davey1, Patrick McGorry1; 1The National Centre of Excellence in Youth Mental Health, Orygen, Australia
Similar to cancer staging in general medicine, the clinical staging model in psychiatry aims to define current stage of disorder development and assist in treatment selection. Clinical stages range from a pre-symptomatic at-risk state (Stage 0) to severe, unremitted illness (Stage 4). The CHARMS criteria (Clinical High At-Risk Mental State) aim to identify young people at pluripotential risk (Stage 1b) of a range of full-threshold (Stage 2) disorders, including severe depression, psychosis, mania, and borderline personality disorder. The CHARMS study is an ongoing cohort study of help-seeking young people aged 12-25 attending youth mental health services in Melbourne, Australia. New referrals meeting the CHARMS criteria are allocated to CHARMS+ (Stage 1b); referrals under CHARMS threshold are allocated to CHARMS- (Stage 0-1a). Transition status and clinical/functional outcomes are re-assessed at 6 and 12 months. To date, a sample of N=73 participants has been recruited: N=49 (67%) met CHARMS criteria at baseline. At 6 months, 32% of CHARMS+ have transitioned to Stage 2 with a slight increase to 37% at 12 months follow-up. There were no transitions in the CHARMS- group. Our initial results indicate that the CHARMS criteria can be applied in the context of a youth mental health service and may validly identify help-seeking young people at risk of progressing to serious mental disorder. This study is the first to introduce and validate a set of clinical criteria to identify a broader ‘at risk’ patient population, and represents an important advance from the UHR for psychosis approach.
