Online Program

A Qualitative Investigation of Positive and Negative Aspects of Being Identified as "Clinical High Risk for Psychosis"

Wednesday, November 4, 2015

Binoy Shah, B.Sc., Clinical Psychology, Columbia University, New York, NY
Brian TaeHyuk Keum, M.A., University of Maryland, College Park, College Park, MD
Emily He, B.A., Teachers College, Columbia University
Tatiana Philippova, B.S., Harris School of Public Policy Studies, University of Chicago, Chicago, IL
Debbie Huang, Columbia University, New York, NY
Christopher Ceccolini, B.A., Teachers College, Columbia University, New York, NY
Jun Hong Chen, BA, Teachers College, Columbia University, New York, NY
Carolina Gouguenheim, department of Clinical Psychology, Teachers College, Columbia University, Glendale, CA
Kiara Moore, M.S.W., School of Social Work, Columbia University, New York, NY
Early identification of the clinical high risk (CHR) state for psychosis, characterized by subthreshold psychotic symptoms, may reduce incidence and improve course of psychotic disorders. However, CHR designation potentially places youths at risk of being stigmatized at the individual, family, and institutional levels. Based on “modified labeling theory”, such identification might lead to harmful stereotypes that are associated with “psychosis”.

Ten participants (aged 12-30) who met criteria for at least one of three “prodromal” syndromes, as assessed with the Structured Interview for Prodromal Syndromes, recruited at the Center of Prevention and Evaluation (COPE) prodromal research program at Columbia University. Participants were queried for reactions to their identification of increased risk for psychosis, specifically whether it elicited any positive or negative thoughts or feelings, and if it influenced how they saw themselves or how others may see them.

There were 24 instances of positive (N=18) or negative (N=6) responses to participants being told they were at increased risk for psychosis compared to their peers. Positive responses were that the label provided an explanation for prior symptomatic experiences, helping participants to focus on seeking treatment, and achieving long-term goals related to their career and family formation. Negative responses included a perceived risk of being stigmatized as already having psychosis. Some youths acknowledged that this stigma was internalized and self-directed, though others claimed to resist stigmatization entirely. Others explained that they were worried that the label would affect future career/family goals and were  “constantly on the lookout” for symptoms of potential psychosis.

Learning Areas:

Administer health education strategies, interventions and programs
Assessment of individual and community needs for health education
Other professions or practice related to public health
Planning of health education strategies, interventions, and programs
Social and behavioral sciences

Learning Objectives:
Demonstrate the subjective experiences related to the CHR label in adolescents and young adults who have been identified as at CHR for psychosis. Differentiate perceived positive and negative effects of youths being told they were at risk for psychosis based on current symptoms. Describe positive effects of CHR label such as providing explanation or a framework for one’s symptoms, “normalizing” the symptoms, focusing on treatments, maintaining functioning, and increasing a sense of control Describe negative effects of CHR label such as prompt stereotypes, anticipated stigma, and worry about the future. Identify specific experiences associated with the CHR label, which is important for developing strategies to reduce stigma in young people in conjunction with benefits from education and preventive interventions that psychosis treatment programs may offer.

Keyword(s): Mental Health, Mental Health Treatment &Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been working as a research assistant in Dr. Lawrence Yang's lab for a year now. I have been a core member in the Clinical High Risk for Psychosis Project since I joined the lab, and I have helped with data collection, processing and analysis.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.