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Prediction of psychosis in adolescents and young adults at high risk: results from the prospective European prediction of psychosis study.
Arch Gen Psychiatry. 2010 Mar; 67(3):241-51.AG

Abstract

CONTEXT

Indicated prevention is currently regarded as the most promising strategy to attenuate, delay, or even avert psychosis. Existing criteria need improvement in terms of specificity and individual risk assessment to allow for better targeted and earlier interventions.

OBJECTIVE

To develop a differential predictive clinical model of transition to first-episode psychosis.

DESIGN

Prospective multicenter, naturalistic field study with a total follow-up time of 18 months.

SETTING

Six early-detection outpatient centers in Germany, Finland, the Netherlands, and England.

PARTICIPANTS

Two hundred forty-five help-seeking patients in a putatively prodromal state of psychosis according to either ultra-high-risk (UHR) criteria or the basic symptom-based criterion cognitive disturbances (COGDIS).

MAIN OUTCOME MEASURE

Incidence of transition to psychosis.

RESULTS

At 18-month follow-up, the incidence rate for transition to psychosis was 19%. Combining UHR and COGDIS yielded the best sensitivity. A prediction model was developed and included positive symptoms, bizarre thinking, sleep disturbances, a schizotypal disorder, level of functioning in the past year, and years of education. With a positive likelihood ratio of 19.9, an area under the curve of 80.8%, and a positive predictive value of 83.3%, diagnostic accuracy was excellent. A 4-level prognostic index further classifying the general risk of the whole sample predicted instantaneous incidence rates of up to 85% and allowed for an estimation of time to transition.

CONCLUSIONS

The prediction model identified an increased risk of psychosis with appropriate prognostic accuracy in our sample. A 2-step risk assessment is proposed, with UHR and cognitive disturbance criteria serving as first-step criteria for general risk and the prognostic index as a second-step tool for further risk classification of each patient. This strategy will allow clinicians to target preventive measures and will support efforts to unveil the biological and environmental mechanisms underlying progression to psychosis.

Authors+Show Affiliations

Department of Psychiatry and Psychotherapy, University of Cologne, Kerpener Strasse 62, 50924 Cologne, Germany. stephan.ruhrmann@uk-koeln.deNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

20194824

Citation

Ruhrmann, Stephan, et al. "Prediction of Psychosis in Adolescents and Young Adults at High Risk: Results From the Prospective European Prediction of Psychosis Study." Archives of General Psychiatry, vol. 67, no. 3, 2010, pp. 241-51.
Ruhrmann S, Schultze-Lutter F, Salokangas RK, et al. Prediction of psychosis in adolescents and young adults at high risk: results from the prospective European prediction of psychosis study. Arch Gen Psychiatry. 2010;67(3):241-51.
Ruhrmann, S., Schultze-Lutter, F., Salokangas, R. K., Heinimaa, M., Linszen, D., Dingemans, P., Birchwood, M., Patterson, P., Juckel, G., Heinz, A., Morrison, A., Lewis, S., von Reventlow, H. G., & Klosterkötter, J. (2010). Prediction of psychosis in adolescents and young adults at high risk: results from the prospective European prediction of psychosis study. Archives of General Psychiatry, 67(3), 241-51. https://doi.org/10.1001/archgenpsychiatry.2009.206
Ruhrmann S, et al. Prediction of Psychosis in Adolescents and Young Adults at High Risk: Results From the Prospective European Prediction of Psychosis Study. Arch Gen Psychiatry. 2010;67(3):241-51. PubMed PMID: 20194824.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prediction of psychosis in adolescents and young adults at high risk: results from the prospective European prediction of psychosis study. AU - Ruhrmann,Stephan, AU - Schultze-Lutter,Frauke, AU - Salokangas,Raimo K R, AU - Heinimaa,Markus, AU - Linszen,Don, AU - Dingemans,Peter, AU - Birchwood,Max, AU - Patterson,Paul, AU - Juckel,Georg, AU - Heinz,Andreas, AU - Morrison,Anthony, AU - Lewis,Shôn, AU - von Reventlow,Heinrich Graf, AU - Klosterkötter,Joachim, PY - 2010/3/3/entrez PY - 2010/3/3/pubmed PY - 2010/3/18/medline SP - 241 EP - 51 JF - Archives of general psychiatry JO - Arch Gen Psychiatry VL - 67 IS - 3 N2 - CONTEXT: Indicated prevention is currently regarded as the most promising strategy to attenuate, delay, or even avert psychosis. Existing criteria need improvement in terms of specificity and individual risk assessment to allow for better targeted and earlier interventions. OBJECTIVE: To develop a differential predictive clinical model of transition to first-episode psychosis. DESIGN: Prospective multicenter, naturalistic field study with a total follow-up time of 18 months. SETTING: Six early-detection outpatient centers in Germany, Finland, the Netherlands, and England. PARTICIPANTS: Two hundred forty-five help-seeking patients in a putatively prodromal state of psychosis according to either ultra-high-risk (UHR) criteria or the basic symptom-based criterion cognitive disturbances (COGDIS). MAIN OUTCOME MEASURE: Incidence of transition to psychosis. RESULTS: At 18-month follow-up, the incidence rate for transition to psychosis was 19%. Combining UHR and COGDIS yielded the best sensitivity. A prediction model was developed and included positive symptoms, bizarre thinking, sleep disturbances, a schizotypal disorder, level of functioning in the past year, and years of education. With a positive likelihood ratio of 19.9, an area under the curve of 80.8%, and a positive predictive value of 83.3%, diagnostic accuracy was excellent. A 4-level prognostic index further classifying the general risk of the whole sample predicted instantaneous incidence rates of up to 85% and allowed for an estimation of time to transition. CONCLUSIONS: The prediction model identified an increased risk of psychosis with appropriate prognostic accuracy in our sample. A 2-step risk assessment is proposed, with UHR and cognitive disturbance criteria serving as first-step criteria for general risk and the prognostic index as a second-step tool for further risk classification of each patient. This strategy will allow clinicians to target preventive measures and will support efforts to unveil the biological and environmental mechanisms underlying progression to psychosis. SN - 1538-3636 UR - https://www.unboundmedicine.com/medline/citation/20194824/Prediction_of_psychosis_in_adolescents_and_young_adults_at_high_risk:_results_from_the_prospective_European_prediction_of_psychosis_study_ L2 - https://jamanetwork.com/journals/jamapsychiatry/fullarticle/10.1001/archgenpsychiatry.2009.206 DB - PRIME DP - Unbound Medicine ER -