PRIME Psychosis Prodrome Research Clinic

About PRIME

The PRIME Research Clinic is specifically designed for persons, ages 12 to 40, who are experiencing worrisome changes in their thoughts, experiences, and/or feelings. These changes may indicate risk factors for serious mental illness. Risk factors include: suspiciousness, odd thinking or behavior, increased difficulty at work or school, withdrawal from loved ones, and changes in emotions.

Mission

To study the course of symptoms which are sometimes prodromal for psychosis and to prevent the development of frank psychosis and schizophrenia.

How PRIME Can Help

As with physical illnesses, the early identification and treatment of mental and emotional problems can lead to a better prognosis. The longer an illness is left untreated, the greater is the disruption to the person's ability to study, work, meet new friends, and socialize comfortably.

The PRIME Research Clinic aims to reduce early symptoms of serious mental illness. At PRIME, people have the opportunity to discuss their concerns and participate in research studies focusing on identifying, monitoring and managing troubling symptoms and at-risk signs of serious mental illness.

Comprehensive Services of the PRIME Clinic

  • Free clinical evaluations and assessment
  • Supportive counseling
  • Follow-along monitoring
  • Clinical treatment with medication, if eligible
  • Neuropsychological testing
  • Magnetic resonance imaging (MRI) evaluations
  • Community education
  • Free treatment
  • Collaboration with community providers and schools

Research Portfolio

  • Studies on Prediction and Prevention of Psychosis
  • Diagnostic Evaluation
  • Counseling
  • Brain imaging (MRI, EEG)
  • Cognitive Evaluation
  • Genetics

Who is Eligible?

  • Individuals diagnosed with a prodromal syndrome (ages 12-40)
  • Healthy controls (ages 12-40)

Benefits of Early Intervention

The goal of early identification and intervention is to minimize a decline in functioning and maximize the return to a previous level of functioning. By identifying and treating the early signs of risk, it is hoped that mental illness may be delayed, prevented, or reduced in intensity.

Special Recognition

The Child Welfare League of America recognized the PRIME Research Clinic of Yale University for its commitment to research of serious mental illness.

Our Executive Staff

  • Scott W. Woods, MD , Director. With 30 years of experience and over 300 publications on the treatment and research of serious mental illness, Dr. Woods is a leader in the field of early intervention and also serves as a full professor at Yale.
  • Barbara C. Walsh, PhD , Clinical Coordinator. Extensive experience in family, child, and adolescent therapy mark Dr. Walsh’s clinical training. Dr. Walsh oversees the clinical evaluation and treatment performed at PRIME.
  • Thomas H. McGlashan, MD , Scientific Advisor. Dr. McGlashan is a pioneer in the early intervention of serious mental illness and one of the founders of the PRIME Clinic. With over 400 publications and as a full professor at Yale, we are privileged that he advises our researchers and clinicians.

In Memoriam

Tandy Miller, PhD, Clinical Director, 1998-2005

SIPS: Structured Interview for Psychosis-risk Syndromes

The PRIME Clinic will conduct this evaluation free for persons aged 12 – 35. The evaluation can take anywhere from 45 minutes to two hours. Persons under the age of 18 must be accompanied by a parent/guardian. The evaluator will meet with the parent and child together for a short period to gather background information. Then the parent will step out while we conduct the bulk of the interview with the young person alone. At the end of the assessment we will give the results of the assessment to the parent and young person. Treatment options can be discussed at this time. It should be noted that this diagnostic evaluation is done for free whether or not a person wants treatment at the clinic.

The Structured Interview of Psychosis-risk Syndromes (SIPS) is a structured interview for diagnosing a clinical high risk (CHR) syndrome for psychosis and cases of first episode psychosis (McGlashan et al., 2010). It contains a severity rating scale (the Scale Of Psychosis-risk Symptoms, or SOPS), a well-anchored Global Assessment of Functioning (GAF) (Hall, 1995), the DSM-IV schizotypal personality disorder checklist, a brief assessment of the family history of psychosis, and the Criteria Of Psychosis-risk Syndromes (COPS) and Presence Of Psychosis Scale (POPS) and DSM-5 Attenuated Psychosis Syndrome criterion sets.

The SIPS rules in or out the current and lifetime presence of psychosis and when psychosis has never been present diagnoses three CHR syndromes. The first and most common CHR syndrome is Attenuated Psychotic Symptom Syndrome (APSS). The full criteria are listed in the instrument, but succinctly it requires one or more subthreshold positive symptoms that have been present in the last month and have begun or worsened in the last year. This most common CHR syndrome is the one that maps onto DSM-s Attenuated Psychosis Syndrome. The second CHR syndrome, Brief Intermittent Psychosis Syndrome (BIPS) permits one or more symptoms at a psychotic intensity, but only intermittently and for a short span of time. The third syndrome, Genetic Risk and Deterioration (GRD), requires a family history of psychosis or a personal history of schizotypal personality disorder along with a 30% decline in the GAF over the past year. CHR syndrome subjects may meet criteria for one of the syndromes, any two, or all three. The criteria for these three syndromes are known as the COPS criteria (Criteria of Psychosis-risk Syndromes).

The three CHR syndromes are designed to predict the onset of psychosis as a broad construct, not only schizophrenic psychosis but also affective psychosis.

Certification training in the use of the SIPS/SOPS instruments is available through the PRIME Clinic. A trainer will come to your site and conduct the two-day training for professionals interested in early identification work. For further information on specifics of the training, costs for the training and availability, please contact Dr. Barbara C. Walsh at barbara.walsh@yale.edu or by calling 203-974-7052.

Contact Us

For more information about the clinic and our research programs, please call Dr. Barbara Walsh at 203-974-7052

Location

Connecticut Mental Health Center B-38
34 Park Street
New Haven, CT 06519
Srihari, Walsh, Woods

From left, Vinod Srihari, MD, Associate Professor of Psychiatry at Yale School of Medicine; Barbara Walsh, PhD, Clinical Coordinator for the PRIME Clinic; and Scott Woods, MD, Professor of Psychiatry, were among 30 experts who participated in the meeting, "Clinical High Risk for Psychosis," on July 27 and 28, 2017, at the Substance Abuse and Mental Health Services Administration (SAMHSA) in Rockville, MD. The purpose of the meeting was to create the groundwork to develop a national strategy for early psychosis to include evidence-based interventions for individuals who are at Clinical High Risk for Psychosis. Participants reviewed findings from completed and ongoing Randomized Controlled Trials and other relevant studies, and evaluated which interventions are ready for implementation in community treatment settings in the United States. The meeting was jointly hosted by SAMHSA and the National Institute of Mental Health (NIMH).
What is Prodrome?

“Prodrome” or Clinical High Risk (CHR) refers to the early symptoms of an illness which alert us to the fact that a young person may be at a higher risk of developing a fully developed psychotic disorder, or a period of disturbance which represents a deviation from a person’s previous experience and behaviors.
Why is it Important to Identify Prodormal Phase Early?
Certain constellations of prodromal symptoms have recently been shown to predict the onset of psychosis with a high degree of accuracy, thus making treatment intervention in the prodromal phase more feasible scientifically and ethically. Schizophrenia and other psychotic disorders are often preceded by prodromal changes, lasting for periods ranging from several days to several years, which foreshadow the onset of illness. The prodromal phase is potentially important in defining markers of risk for progression to psychotic illness and investigating novel biological and psychological treatments to prevent a transition to psychosis. Early identification of symptoms leads to a better prognosis not only in the short term but even in long term.

It is essential to have a specialized assessment carried out to determine whether the person actually meets criteria for the clinical high risk phase. We should recognize that youth meeting clinical high risk criteria are help seeking and in need of care whether or not they develop a full psychotic disorder. Those in high risk should be monitored closely for progression to full psychosis through monthly assessments. Co-existing conditions such as anxiety and depression should be treated as appropriate. It’s important to provide psychosocial support and include the family in the services.
What are some of the behaviors of concern that could be indicative of prodromal syndromes?

You are looking for a change in the young person – either the beginning or worsening of:

1. Withdrawal/Isolation; 2. Social Difficulties; 3. Poor Hygiene; 4. Bizarre Behavior/Appearance; 5. Increased difficulty at school or work; 6. Falling Asleep in Class Repeatedly; 7. Sadness/Tearfulness; 8. Excessive Anxiety; 9. Absenteeism/Staying in Room; 10. Poor Concentration/Spacing Out/Difficulty thinking clearly; 11. Hypervigilance; 12. Decrease in Work Performance/Activity Level; 13. Becoming Neglectful and Unfeeling; 14. Suspiciousness or mistrust of others; 15. Changes in the way things look or sound; 16. Emotional Outbursts/Emotional Flatness
What is Psychosis?

Psychosis is any severe mental disorder in which contact with reality is lost or distorted. Schizophrenia is the most common psychosis. Psychotic disorders are complex and appear to involve multiple susceptibility genes interacting with multiple environmental factors throughout the development of the person. The nature of these interactions is very complex and poorly understood at this time. In order to avoid the deterministic viewpoint of mental illness, it is crucial to emphasize the importance of the environment and lifestyle choices and that there is hope for recovery. Taking illicit drugs is a preventable risk factor, as is excess stress.

Statistics on psychosis:

  • Prevalence rate is 1 percent worldwide
  • Median age of onset is 19
  • The most vulnerable age of psychosis is 12 to 25
  • 85 percent have onset by age 35

There are positive and negative symptoms for schizophrenia. Positive symptoms include hallucinations, delusions, thought disorder and bizarre behaviors. Negative symptoms include lack of interest, lack of motivation, lack of pleasure, social withdrawal, blunted affect, lethargy, and apathy.

Psychotic illnesses exact a tremendous cost to individuals, as well as to their families and communities. Among the costs are lost productivity; increased family stress; increased physical illnesses; diminished self-esteem; increased dependency; repeated need for hospitalizations; inability to maintain friendships; and difficulty attaining life goals, such as completing school and working.

According to the World Health Organization, early treatment for psychosis can reduce relapse of acute symptoms by more than 50%, returning young people to wellness, and offering a clearer path toward prevention.