The "Parma At-Risk mental states" (PARMS) program: General description and process analysis after 5 years of clinical activity.

Aim: From January 2016, the Parma Department of Mental Health developed a specialized care protocol – the ‘Parma At-Risk Mental States’ (PARMS) program – as a diffused service for early intervention in individuals at Clinical High Risk for Psychosis (CHR-P). The aims of this investigation were (1) to describe the PARMS structural organization and (2) to examine specific process indicators during the first 5 years of its clinical activity. Methods: All participants were adolescent and young adult help-seekers (aged 12–25 years) at CHR-P in accordance with well-defined psychometric criteria. Results: At entry, 52 subjects were provided with a dedicated protocol of care and only 14 dropped out during the first year of treatment. The Duration of Untreated Illness (DUI) overall decreased over time. Most of CHR-P participants suffered from ‘Attenuated Psychotic Symptoms’ and ‘Brief, Limited, Intermittent Psychotic Symptoms’ in the same percentage (48.1% [n = 25]). The most common DSM-IV-TR diagnosis was schizotypal personality disorder, followed by borderline personality disorder and brief psychotic disorder. Conclusions: A specialized, evidence-based care protocol for CHR-P individuals within Italian adult and child/adolescent psychiatric services is feasible, also in adolescents, who have a high risk of falling through the child/adult service gap.