Psychosis Prediction: Stratification of Risk Estimation With Information-Processing and Premorbid Functioning Variables

Nieman, Dorien H.; Ruhrmann, Stephan; Dragt, Sara; Soen, Francesca; Tricht, Mirjam J. van; Koelman, J.H.T.M.; Bour, L.J.; Velthorst, Eva; Becker, Hiske E.; Weiser, Mark; Linszen, Don; Haan, Lieuwe de

doi:10.1093/schbul/sbt145

Cited by 90 publications

(97 citation statements)

References 53 publications

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“…Furthermore, a 'one-fits-all' approach most likely does not measure up to the considerable heterogeneity of conversion rates even in CHR samples of equal intake criteria. Future early detection approaches should therefore define different CHR groups that are identified, for example, by a risk stratification approach, which might consider most likely level of functioning but also other potential predictors such as neurocognitive or neurobiological abnormalities [5,11,54,67,80,87].…”

Section: Discussionmentioning

confidence: 99%

EPA guidance on the early detection of clinical high risk states of psychoses

et al. 2015

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The aim of this guidance paper of the European Psychiatric Association is to provide evidence-based recommendations on the early detection of a clinical high risk (CHR) for psychosis in patients with mental problems. To this aim, we conducted a meta-analysis of studies reporting on conversion rates to psychosis in non-overlapping samples meeting any at least any one of the main CHR criteria: ultra-high risk (UHR) and/or basic symptoms criteria. Further, effects of potential moderators (different UHR criteria definitions, single UHR criteria and age) on conversion rates were examined. Conversion rates in the identified 42 samples with altogether more than 4000 CHR patients who had mainly been identified by UHR criteria and/or the basic symptom criterion 'cognitive disturbances' (COGDIS) showed considerable heterogeneity. While UHR criteria and COGDIS were related to similar conversion rates until 2-year follow-up, conversion rates of COGDIS were significantly higher thereafter. Differences in onset and frequency requirements of symptomatic UHR criteria or in their different consideration of functional decline, substance use and co-morbidity did not seem to impact on conversion rates. The 'genetic risk and functional decline' UHR criterion was rarely met and only showed an insignificant pooled sample effect. However, age significantly affected UHR conversion rates with lower rates in children and adolescents. Although more research into potential sources of heterogeneity in conversion rates is needed to facilitate improvement of CHR criteria, six evidence-based recommendations for an early detection of psychosis were developed as a basis for the EPA guidance on early intervention in CHR states.

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Section: Discussionmentioning

confidence: 99%

EPA guidance on the early detection of clinical high risk states of psychoses

et al. 2015

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“…The first step is to improve prediction by calculating a risk index for a homogeneous high-risk group (e.g., use of a narrow definition and a restricted age range) from a set of theoretically derived potential predictors. The second step is to apply the resulting index to stratify risk within the overall group, consistent with the approach used by Ruhrmann et al (20, 49, 50). The risk index score distribution generated in the present sample suggests that adolescents with the lowest scores can be considered to be at minimal risk and those with scores at the high end at very high risk, with the risk of the middle group somewhat uncertain.…”

Section: Discussionmentioning

confidence: 99%

Psychosis Prevention: A Modified Clinical High Risk Perspective From the Recognition and Prevention (RAP) Program

Cornblatt¹,

Carrión²,

Auther³

et al. 2015

AJP

134

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Objective Early intervention and prevention of psychosis remain a major challenge. Prediction would be greatly advanced with improved ability to identify individuals at true risk, which, at present, is moderate at best. The authors tested a modified strategy to improve prediction by selecting a more homogeneous high-risk sample (attenuated positive symptom criteria only, age range of mid-teens to early 20s) than is currently standard, combined with a systematic selection of neurodevelopmental deficits. Method A sample of 101 treatment-seeking adolescents (mean age, 15.9 years) at clinical high risk for psychosis were followed clinically for up to 5 years (mean follow-up time, 3.0 years, SD=1.6). Adolescents were included only if they exhibited one or more attenuated positive symptoms at moderate to severe, but not psychotic, severity levels. Cox regression was used to derive a risk index. Results The overall conversion rate to psychosis was 28.3%. The final predictor model, with a positive predictive validity of 81.8%, consisted of four variables: disorganized communication, suspiciousness, verbal memory deficits, and decline in social functioning during follow-up. Significant effects also suggest narrowing the risk age range to 15–22 years. Conclusions Clinical high risk criteria that emphasize disorganized communication and suspiciousness while also including compromised verbal memory and declining social functioning have the potential to improve predictive accuracy compared with attenuated positive symptoms used alone. On the resulting risk index (a weighted combination of the predictors), low scores were interpreted as signifying minimal risk, with little treatment necessary, high scores as suggesting aggressive intervention, and intermediate scores, although less informative, as supporting psychosocial treatment.

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“…These neuro-and social-cognitive abnormalities are also accompanied by various abnormalities in functional and structural imaging [11,52,107], electrophysiological measures [10,85,118], and neurochemistry [19,33,55]. In summary, CHR patients are in need for treatment -independent of any potential risk to develop psychosis in the future [96].…”

Section: Need For Treatment In Clinical High Risk States Of Psychosesmentioning

confidence: 99%

EPA guidance on the early intervention in clinical high risk states of psychoses

et al. 2015

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This guidance paper from the European Psychiatric Association (EPA) aims to provide evidence-based recommendations on early intervention in clinical high risk (CHR) states of psychosis, assessed according to the EPA guidance on early detection. The recommendations were derived from a meta-analysis of current empirical evidence on the efficacy of psychological and pharmacological interventions in CHR samples. Eligible studies had to investigate conversion rate and/or functioning as a treatment outcome in CHR patients defined by the ultra-high risk and/or basic symptom criteria. Besides analyses on treatment effects on conversion rate and functional outcome, age and type of intervention were examined as potential moderators. Based on data from 15 studies (n=1394), early intervention generally produced significantly reduced conversion rates at 6- to 48-month follow-up compared to control conditions. However, early intervention failed to achieve significantly greater functional improvements because both early intervention and control conditions produced similar positive effects. With regard to the type of intervention, both psychological and pharmacological interventions produced significant effects on conversion rates, but not on functional outcome relative to the control conditions. Early intervention in youth samples was generally less effective than in predominantly adult samples. Seven evidence-based recommendations for early intervention in CHR samples could have been formulated, although more studies are needed to investigate the specificity of treatment effects and potential age effects in order to tailor interventions to the individual treatment needs and risk status.

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Psychosis Prediction: Stratification of Risk Estimation With Information-Processing and Premorbid Functioning Variables

Abstract: Our results suggest that predicting a first psychotic episode in CHR subjects could be improved with a model including premorbid adjustment and information-processing variables in a multistep algorithm combining risk detection and stratification.

Cited by 90 publications

References 53 publications

EPA guidance on the early detection of clinical high risk states of psychoses

EPA guidance on the early detection of clinical high risk states of psychoses

Psychosis Prevention: A Modified Clinical High Risk Perspective From the Recognition and Prevention (RAP) Program

EPA guidance on the early intervention in clinical high risk states of psychoses

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