Question: For people at potential risk of developing first episode psychosis, what is the most sensitive, valid, reliable and time-effective test for assessing at-risk mental state?

Answer:

Plain language summary
CAARMS has been identified as the most valid tool for assessing "at risk mental state" as it can successfully identify "at risk" patients using its own Ultra High Risk (UHR) criteria. Stronger evidence is needed to support the reliability of other "at risk" assessment tools that have used CAARMS as a point of reference.

Clinical and research implications
There are currently no reliable estimates of the performance of tests to assess at risk mental state.

Future studies should include assessment of test performance using pre-defined cut-off values, i.e. the performance of the test should be independently evaluated in a separate population from that in which its operating characteristics have been determined. Studies should also consider the selection of an appropriate population (one which is representative of the intended use of the test) and an appropriate reference standard. The reference standard used by studies in this summary (Comprehensive Assessment of At-Risk Mental States, CAARMS) is likely to be a valid tool for identifying individuals at increased risk of developing psychosis. However, it should be noted identification of an "at risk" group is not the same as prediction of the actual onset of psychosis; baseline CAARMS alone has a low positive predictive value for psychosis when used in a non-psychotic help seeking population. It may be appropriate to consider undertaking prediction modelling studies, in the target population, to determine which components of CAARMS or other instruments, as well as other risk factors (e.g. socio-economic factors, history of substance

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