Improving the clinical prediction of psychosis by combining ultra-high risk criteria and cognitive basic symptoms

AbstractBackgroundAn efficient indicated prevention of psychotic disorders requires valid risk criteria that work in both clinical and community samples. Yet, ultra-high risk and basic symptom criteria were recently recommended for use in clinical samples only. Their use in the community was discouraged for lack of knowledge about their prevalence, clinical relevance and risk factors in non-clinical, community settings when validly assessed with the same instruments used in the clinic.MethodsUsing semi-structured telephone interviews with established psychosis-risk instruments, we studied the prevalence of psychosis-risk symptoms and criteria, their clinical relevance (using presence of a non-psychotic mental disorder or of functional deficits as proxy measures) and their risk factors in a random, representative young adult community sample (N=2683; age 16–40 years; response rate: 63.4%).ResultsThe point-prevalence of psychosis-risk symptoms was 13.8%. As these mostly occurred too infrequent to meet frequency requirements of psychosis-risk criteria, only 2.4% of participants met psychosis-risk criteria. A stepwise relationship underlay the association of ultra-high risk and basic symptoms with proxy measures of clinical relevance, this being most significant when both occurred together. In line with models of their formation, basic symptoms were selectively associated with age, ultra-high risk symptoms with traumatic events and lifetime substance misuse.ConclusionsPsychosis-risk criteria were uncommon, indicating little risk of falsely labelling individuals from the community at-risk for psychosis. Besides, both psychosis-risk symptoms and criteria seem to possess sufficient clinical relevance to warrant their broader attention in clinical practice, especially if ultra-high risk and basic symptoms occur together.

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Predicting the development of schizophrenia in high-risk populations: Systematic review of the predictive validity of prodromal criteria

The British Journal of Psychiatry ◽

10.1192/bjp.bp.110.086868 ◽

2011 ◽

Vol 199 (5) ◽

pp. 361-366 ◽

Cited By ~ 22

Author(s):

Jefter Chuma ◽

Prem Mahadun

Keyword(s):

Systematic Review ◽

High Risk ◽

Sensitivity And Specificity ◽

Predictive Validity ◽

Evidence Base ◽

Prodromal Stage ◽

Basic Symptoms ◽

Risk Criteria ◽

Ultra High Risk ◽

High Risk Populations

BackgroundThere is a great deal of debate on the usefulness and accuracy of prodromal criteria in predicting schizophrenia. The risk of treating people who screen false positive with medication is considerable. Yet intervening during the prodromal stage of illness may reduce the burden caused by schizophrenia.AimsTo draw together the evidence base for the predictive validity of prodromal criteria in identifying individuals at high risk of developing schizophrenia.MethodWe conducted a systematic review of prospective studies investigating the predictive validity of prodromal criteria in schizophrenia.ResultsOur study found two main criteria, ultra-high-risk criteria and basic-symptoms criteria, used in studies investigating the predictive validity of prodromal symptoms. The sensitivity and specificity of ultra-high-risk criteria was 0.81 (95% CI 0.76–0.85) and 0.67 (95% CI 0.64–0.70) respectively and for basic-symptoms criteria sensitivity and specificity was 0.97 (95% CI 0.91–1.00) and 0.59 (95% CI 0.48–0.70) respectively.ConclusionsBoth ultra-high-risk criteria and basic-symptoms criteria are useful in predicting the development of schizophrenia among high-risk populations.

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SU50. Schizotypy Moderates the Effect of Basic Symptoms on Conversion to Overt Psychosis in Individuals at Ultra-High Risk for Psychosis

Schizophrenia Bulletin ◽

10.1093/schbul/sbx024.048 ◽

2017 ◽

Vol 43 (suppl_1) ◽

pp. S179-S179

Author(s):

Minji Bang ◽

Jin Young Park ◽

Kyung Ran Kim ◽

Su Young Lee ◽

Yun Young Song ◽

...

Keyword(s):

High Risk ◽

Basic Symptoms ◽

Ultra High Risk

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Basic symptoms and gray matter volumes of patients at clinical high risk for psychosis

Psychological Medicine ◽

10.1017/s0033291720001282 ◽

2020 ◽

pp. 1-9 ◽

Cited By ~ 1

Author(s):

Daniela Hubl ◽

Chantal Michel ◽

Frauke Schultze-Lutter ◽

Martinus Hauf ◽

Benno G. Schimmelmann ◽

...

Keyword(s):

High Risk ◽

Gray Matter ◽

First Episode ◽

Clinical High Risk ◽

Significant Group ◽

Basic Symptoms ◽

Conversion Rates ◽

Episode Psychosis ◽

Ultra High Risk ◽

Gray Matter Volumes

Abstract Background Clinical high-risk (CHR) for psychosis is indicated by ultra-high risk (UHR) and basic symptom (BS) criteria; however, conversion rates are highest when both UHR and BS criteria are fulfilled (UHR&BS). While BSs are considered the most immediate expression of neurobiological aberrations underlying the development of psychosis, research on neurobiological correlates of BS is scarce. Methods We investigated gray matter volumes (GMV) of 20 regions of interest (ROI) previously associated with UHR criteria in 90 patients from the Bern early detection service: clinical controls (CC), first-episode psychosis (FEP), UHR, BS and UHR&BS. We expected lowest GMV in FEP and UHR&BS, and highest volume in CC with UHR and BS in-between. Results Significantly, lower GMV was detected in FEP and UHR&BS patients relative to CC with no other significant between-group differences. When ROIs were analyzed separately, seven showed a significant group effect (FDR corrected), with five (inferior parietal, medial orbitofrontal, lateral occipital, middle temporal, precuneus) showing significantly lower GM volume in the FEP and/or UHR&BS groups than in the CC group (Bonferroni corrected). In the CHR group, only COGDIS scores correlated negatively with cortical volumes. Conclusions This is the first study to demonstrate that patients who fulfill both UHR and BS criteria – a population that has been associated with higher conversion rates – exhibit more severe GMV reductions relative to those who satisfy BS or UHR criteria alone. This result was mediated by the BS in the UHR&BS group, as only the severity of BS was linked to GMV reductions.

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Attenuated psychotic and basic symptom characteristics in adolescents with ultra-high risk criteria for psychosis, other non-psychotic psychiatric disorders and early-onset psychosis

European Child & Adolescent Psychiatry ◽

10.1007/s00787-016-0832-7 ◽

2016 ◽

Vol 25 (10) ◽

pp. 1091-1102 ◽

Cited By ~ 20

Author(s):

Nella Lo Cascio ◽

Riccardo Saba ◽

Marta Hauser ◽

Ditte Lammers Vernal ◽

Aseel Al-Jadiri ◽

...

Keyword(s):

High Risk ◽

Psychiatric Disorders ◽

Early Onset ◽

Risk Criteria ◽

Ultra High Risk ◽

Early Onset Psychosis

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Checking the predictive accuracy of basic symptoms against ultra high-risk criteria and testing of a multivariable prediction model: Evidence from a prospective three-year observational study of persons at clinical high-risk for psychosis

European Psychiatry ◽

10.1016/j.eurpsy.2017.05.026 ◽

2017 ◽

Vol 45 ◽

pp. 27-35 ◽

Cited By ~ 10

Author(s):

M.P. Hengartner ◽

K. Heekeren ◽

D. Dvorsky ◽

S. Walitza ◽

W. Rössler ◽

...

Keyword(s):

High Risk ◽

Prediction Model ◽

Sensitivity And Specificity ◽

Predictive Value ◽

Predictive Accuracy ◽

Positive Symptoms ◽

Clinical High Risk ◽

Verbal Iq ◽

Basic Symptoms ◽

Ultra High Risk

AbstractBackground:The aim of this study was to critically examine the prognostic validity of various clinical high-risk (CHR) criteria alone and in combination with additional clinical characteristics.Methods:A total of 188 CHR positive persons from the region of Zurich, Switzerland (mean age 20.5 years; 60.2% male), meeting ultra high-risk (UHR) and/or basic symptoms (BS) criteria, were followed over three years. The test battery included the Structured Interview for Prodromal Syndromes (SIPS), verbal IQ and many other screening tools. Conversion to psychosis was defined according to ICD-10 criteria for schizophrenia (F20) or brief psychotic disorder (F23).Results:Altogether n = 24 persons developed manifest psychosis within three years and according to Kaplan–Meier survival analysis, the projected conversion rate was 17.5%. The predictive accuracy of UHR was statistically significant but poor (area under the curve [AUC] = 0.65, P < .05), whereas BS did not predict psychosis beyond mere chance (AUC = 0.52, P = .730). Sensitivity and specificity were 0.83 and 0.47 for UHR, and 0.96 and 0.09 for BS. UHR plus BS achieved an AUC = 0.66, with sensitivity and specificity of 0.75 and 0.56. In comparison, baseline antipsychotic medication yielded a predictive accuracy of AUC = 0.62 (sensitivity = 0.42; specificity = 0.82). A multivariable prediction model comprising continuous measures of positive symptoms and verbal IQ achieved a substantially improved prognostic accuracy (AUC = 0.85; sensitivity = 0.86; specificity = 0.85; positive predictive value = 0.54; negative predictive value = 0.97).Conclusions:We showed that BS have no predictive accuracy beyond chance, while UHR criteria poorly predict conversion to psychosis. Combining BS with UHR criteria did not improve the predictive accuracy of UHR alone. In contrast, dimensional measures of both positive symptoms and verbal IQ showed excellent prognostic validity. A critical re-thinking of binary at-risk criteria is necessary in order to improve the prognosis of psychotic disorders.

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Clinical High Risk Symptoms and Criteria in the Community: Prevalence, Clinical Significance and Risk Factors for Their Occurrence

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.2225 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S226-S226

Author(s):

F. Schultze-Lutter ◽

C. Michel ◽

B.G. Schimmelmann ◽

S. Ruhrmann

Keyword(s):

Risk Factors ◽

High Risk ◽

Clinical Relevance ◽

Clinical Samples ◽

Clinical High Risk ◽

Basic Symptoms ◽

Developmental Models ◽

Increased Risk ◽

Ultra High Risk ◽

Competing Interest

IntroductionIn clinical samples, symptomatic ultra-high risk (UHR) criteria and the basic symptom criterion “cognitive disturbances” perform well in predicting psychosis, and best when both approaches are combined.ObjectiveHowever, little-to-nothing is known about clinical high risk (CHR) and their constituent symptoms in the community.AimsWe studied the prevalence, clinical relevance, and moderators of CHR criteria and symptoms in the community.MethodRegression analyses involved 2683 community participants (age 16–40 years; response rate: 63.4%). Semi-structured telephone interviews were performed by well-trained psychologists.ResultsLifetime and current CHR symptoms were reported by 21.1% and 13.8% of interviewees. Frequency of symptoms was mostly low, only 2.4% met any CHR criterion. A stepwise relationship underlay the association of the two types of CHR symptoms and criteria with the presence of mental disorders and functional deficits, with odds ratios being highest (7.4–31.8) when UHR and basic symptoms occurred together. Report of a family history of mental disorder generally increased risk for CHR symptoms. While younger age increased risk for basic symptoms, lifetime substance misuse and trauma increased risk for UHR symptoms.ConclusionsPrevalence of CHR criteria was within the to-be-expected range from prevalence rates of psychoses. Clinical relevance of both CHR symptoms and criteria increased in a stepwise manner from basic symptoms via UHR symptoms to their combined presence, reinforcing the clinical utility of their combined use. The risk factors selectively associated with basic and UHR symptoms support developmental models relating basic symptoms to neurobiological and UHR symptoms to psychological factors.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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