• Vol. 38 No. 5, 442–446
  • 15 May 2009

Comparison of Attitudes of Psychiatrists vs Primary Healthcare Physicians in Singapore Towards At Risk Mental States (ARMS)



Aims: It is possible to define at risk mental states (ARMS) that predict conversion to schizophrenia in up to 40% of help seeking individuals within a year of screening. Treatment of ARMS is controversial due to difficulties with diagnosis and uncertainties of treatment effectiveness. This survey was conducted to assess and compare attitudes of Singapore psychiatrists vs primary healthcare physicians towards ARMS. Materials and Methods: An anonymous survey containing a clinical vignette and questions related to the diagnosis and management of ARMS was sent out to all registered psychiatrists/ psychiatry trainees and all doctors in a public primary healthcare group in Singapore. Results: The response rate was 62.1% (87/140) and 72.3% (107/ 148) for psychiatrists and primary healthcare physicians respectively. The proportion of psychiatrists diagnosing ARMS vs psychosis was 44.8% vs 43.7% respectively. Among primary care physicians, the corresponding proportion was 54.2% vs 40.2%. The difference between the 2 groups did not reach statistical significance. Among psychiatrists who diagnosed ARMS, 74.4% (29/39) would treat the patient with active management. Of the total number of psychiatrists surveryed, 49.4% would advocate population screening of high risk groups compared to 30.8% of primary healthcare physicians. And 64.4% of psychiatrists felt that there was no consensus regarding the management of ARMS. Conclusions: There is currently clinical equipoise with regards to both diagnosis and management of ARMS in Singapore. Primary care physicians may be more likely to diagnose psychosis vs ARMS when compared to psychiatrists. Psychiatrists were more likely than primary healthcare physicians to advocate population screening of ARMS in high-risk groups. Most psychiatrists would manage ARMS actively.

Schizophrenia is a serious psychotic condition characterised by delusions, hallucinations and disordered behaviour. The Global Burden of Disease lists schizophrenia among the top 10 contributors to healthcare burden and disability around the world.1 Most patients who develop schizophrenia experience a prodromal phase2,3 which involves attenuated psychotic symptoms and a worsening of premorbid functioning. The schizophrenia prodrome is essentially a retrospective diagnosis made definitively only after individuals develop schizophrenia. It is possible to identify individuals with at risk mental states (ARMS) and a high likelihood of onset of schizophrenia within a brief follow-up period.4 Up to 10.1% of help seeking individuals meeting the criteria for ARMS converted to psychosis within 6 months of screening5 and up to 40% converted to psychosis within 12 months of being screened.4 This represents an incidence several thousand times the age adjusted incidence rate.

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