Twelve-month psychosis-predictive value of the ultra-high risk criteria in children and adolescents

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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Ultra High Risk Status and Transition to Psychosis in 22q11.2 Deletion Syndrome

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.258 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S81-S82

Author(s):

M. Armando ◽

M. Schneider ◽

M. Pontillo ◽

S. Vicari ◽

M. Debbane ◽

...

Keyword(s):

High Risk ◽

Predictive Value ◽

Transition Rate ◽

22Q11.2 Deletion Syndrome ◽

Human Model ◽

Deletion Syndrome ◽

Additional Contribution ◽

22Q11.2 Deletion ◽

Level Of Functioning ◽

Ultra High Risk

The 22q11.2 deletion syndrome (22q11DS) is characterized by high rates of psychotic symptoms and schizophrenia, making this condition a promising human model for studying risk factors for psychosis. We explored the predictive value of ultra high-risk (UHR) criteria in a sample of patients with 22q11DS. We also examined the additional contribution of sociodemographic, clinical and cognitive variables to predict transition to psychosis within a mean interval of 32.56176 months after initial assessment. Eighty-nine participants with 22q11DS (age range: 8–30 years; mean: 16.1647) were assessed using the structured interview for psychosis-risk syndromes. Information on axis I diagnoses, internalizing and externalizing symptoms, level of functioning and IQ was also collected. At baseline, 22 (24.7%) participants met UHR criteria. Compared to those without a UHR condition, they had a significantly lower functioning, more frequent anxiety disorders and more severe psychopathology. Transition rate to psychosis was 27.3% in UHR and 4.5% in non-UHR participants. Cox regression analyses revealed that UHR status significantly predicted conversion to psychosis. Baseline level of functioning was the only other additional predictor. This is the first study investigating the predictive value of UHR criteria in 22q11DS. It indicates that the clinical path leading to psychosis is broadly comparable to that observed in other clinical high-risk samples. Nevertheless, the relatively high transition rate in non-UHR individuals suggests that other risk markers should be explored in this population. The role of low functioning as a predictor of transition to psychosis should also be investigated more in depth.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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

Schizophrenia Research ◽

10.1016/j.schres.2014.02.010 ◽

2014 ◽

Vol 154 (1-3) ◽

pp. 100-106 ◽

Cited By ~ 83

Author(s):

Frauke Schultze-Lutter ◽

Joachim Klosterkötter ◽

Stephan Ruhrmann

Keyword(s):

High Risk ◽

Clinical Prediction ◽

Basic Symptoms ◽

Risk Criteria ◽

Ultra High Risk

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Why ultra high risk criteria for psychosis prediction do not work well outside clinical samples and what to do about it

World Psychiatry ◽

10.1002/wps.20405 ◽

2017 ◽

Vol 16 (2) ◽

pp. 212-213 ◽

Cited By ~ 28

Author(s):

Paolo Fusar-Poli

Keyword(s):

High Risk ◽

Clinical Samples ◽

Risk Criteria ◽

Ultra High Risk

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Identifying children and adolescents at ultra high risk of psychosis in Italian neuropsychiatry services: a feasibility study

European Child & Adolescent Psychiatry ◽

10.1007/s00787-015-0710-8 ◽

2015 ◽

Vol 25 (1) ◽

pp. 91-106 ◽

Cited By ~ 20

Author(s):

Giulia Spada ◽

S. Molteni ◽

C. Pistone ◽

M. Chiappedi ◽

P. McGuire ◽

...

Keyword(s):

High Risk ◽

Children And Adolescents ◽

Feasibility Study ◽

Ultra High Risk

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Overlooking the transition elephant in the ultra-high-risk room: are we missing functional equivalents of transition to psychosis?

Psychological Medicine ◽

10.1017/s0033291719003337 ◽

2019 ◽

pp. 1-4

Author(s):

Andrea Raballo ◽

Michele Poletti

Keyword(s):

High Risk ◽

Mental State ◽

Predictive Value ◽

Dilution Effect ◽

Transition Rates ◽

Confounding Effect ◽

Ultra High Risk ◽

Unique Outcome

Abstract In the wake of the almost quarter of a century since the conceptualization of ultra-high-risk (UHR) states for psychosis, empirical evidences in the field are constantly scrutinized and re-assessed through meta-analytic lens. Briefly, such scrutiny converges on three major evidences: pretest risk enrichment, risk hierarchy within UHR states, and declining transition rates. While the former two are intuitive, the dilution effect remains elusive and might be rather symptomatic of unsolved issues in the field. Those include the heterogeneously reported antipsychotic (AP) exposure in UHR samples and the almost univocal focus on purely psychometric transition to psychosis. Both issues lead to the neglect of functional equivalents of transition, i.e. that of a mental state at immediate need for AP medication, and might have a cascading confounding effect on the predictive value of contemporary risk calculators centered on criterial transition as a unique outcome.

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Poster #S161 A JOINT LATENT CLASS MODELLING APPROACH FOR THE PREDICTION OF PSYCHOSIS BY BASIC SYMPTOM AND ULTRA-HIGH RISK CRITERIA

Schizophrenia Research ◽

10.1016/s0920-9964(14)70440-2 ◽

2014 ◽

Vol 153 ◽

pp. S147-S148

Author(s):

Stefanie J. Schmidt ◽

Stephan Ruhrmann ◽

Benno G. Schimmelmann ◽

Joachim Klosterkötter ◽

Frauke Schultze-Lutter

Keyword(s):

High Risk ◽

Latent Class ◽

Risk Criteria ◽

Ultra High Risk ◽

Latent Class Modelling ◽

Modelling Approach

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P-1014 - Functional impairment as a criterion for ultra-high risk criteria can induce a critical loss of sensitivity

European Psychiatry ◽

10.1016/s0924-9338(12)75181-7 ◽

2012 ◽

Vol 27 ◽

pp. 1

Author(s):

S. Ruhrmann ◽

F. Schultze-Lutter ◽

M. Bodatsch ◽

D. Linszen ◽

R.K.R. Salokangas ◽

...

Keyword(s):

High Risk ◽

Functional Impairment ◽

Risk Criteria ◽

Ultra High Risk

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Clinical profile, conversion rate, and suicidal thinking and behaviour in children and adolescents at ultra-high risk for psychosis: a theoretical perspective

Research in Psychotherapy Psychopathology Process and Outcome ◽

10.4081/ripppo.2020.455 ◽

2020 ◽

Vol 23 (1) ◽

Author(s):

Maria Pontillo ◽

Maria Cristina Tata ◽

Roberto Averna ◽

Prisca Gargiullo ◽

Silvia Guerrera ◽

...

Keyword(s):

Young Adults ◽

High Risk ◽

Children And Adolescents ◽

Conversion Rate ◽

Theoretical Perspective ◽

Clinical Profile ◽

Psychotic Symptoms ◽

Psychotic Episode ◽

Suicidal Thinking ◽

Ultra High Risk

Over the past years there has been substantial growing interest in the prodromes of psychosis to identify individuals at risk for psychosis prior to their first psychotic episode. Researchers have proposed criteria to detect young adults at Ultra-High Risk (UHR) for psychosis, and these criteria have also been applied to children and adolescents, though few clinical studies have examined this population. This theoretical perspective presents some of the crucial issues in the assessment and treatment of UHR children and adolescents: the presence of a specific clinical profile (i.e., different to that of healthy controls and UHR young adults), the predictive value of UHR criteria, and the presence and clinical significance of suicidal thinking and behaviour. In UHR children and adolescents, like UHR young adults, the presence of Attenuated Psychotic Symptoms (APS) is the most frequently reported inclusion criterion at baseline, with a prevalence of approximately 89–100%. In addition, there are frequently non-psychotic comorbid diagnoses of depressive and anxiety disorders. In contrast to the UHR adult population, UHR children and adolescents demonstrate a lower conversion rate to frank psychosis, most likely due to their high rate of APS. Finally, UHR adolescents report a high prevalence of suicidal ideation and self-injurious behaviour (67.5%), as well as a significantly greater frequency of attempted suicide, relative to adolescents with frank psychosis. On this basis, UHR children and adolescents report a clinical complexity that should be carefully monitored and considered for specific and targeted therapeutic interventions to be planned and developed

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