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An Individualized Risk Calculator for Research in Prodromal Psychosis.
Cannon, Tyrone D; Yu, Changhong; Addington, Jean; Bearden, Carrie E; Cadenhead, Kristin S; Cornblatt, Barbara A; Heinssen, Robert; Jeffries, Clark D; Mathalon, Daniel H; McGlashan, Thomas H; Perkins, Diana O; Seidman, Larry J; Tsuang, Ming T; Walker, Elaine F; Woods, Scott W; Kattan, Michael W.
Afiliação
  • Cannon TD; From the Departments of Psychology and Psychiatry, Yale University, New Haven, Conn.; the Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland; the Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Alberta; the Departments of Psychiatry and Biobehavioral
  • Yu C; From the Departments of Psychology and Psychiatry, Yale University, New Haven, Conn.; the Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland; the Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Alberta; the Departments of Psychiatry and Biobehavioral
  • Addington J; From the Departments of Psychology and Psychiatry, Yale University, New Haven, Conn.; the Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland; the Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Alberta; the Departments of Psychiatry and Biobehavioral
  • Bearden CE; From the Departments of Psychology and Psychiatry, Yale University, New Haven, Conn.; the Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland; the Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Alberta; the Departments of Psychiatry and Biobehavioral
  • Cadenhead KS; From the Departments of Psychology and Psychiatry, Yale University, New Haven, Conn.; the Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland; the Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Alberta; the Departments of Psychiatry and Biobehavioral
  • Cornblatt BA; From the Departments of Psychology and Psychiatry, Yale University, New Haven, Conn.; the Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland; the Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Alberta; the Departments of Psychiatry and Biobehavioral
  • Heinssen R; From the Departments of Psychology and Psychiatry, Yale University, New Haven, Conn.; the Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland; the Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Alberta; the Departments of Psychiatry and Biobehavioral
  • Jeffries CD; From the Departments of Psychology and Psychiatry, Yale University, New Haven, Conn.; the Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland; the Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Alberta; the Departments of Psychiatry and Biobehavioral
  • Mathalon DH; From the Departments of Psychology and Psychiatry, Yale University, New Haven, Conn.; the Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland; the Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Alberta; the Departments of Psychiatry and Biobehavioral
  • McGlashan TH; From the Departments of Psychology and Psychiatry, Yale University, New Haven, Conn.; the Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland; the Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Alberta; the Departments of Psychiatry and Biobehavioral
  • Perkins DO; From the Departments of Psychology and Psychiatry, Yale University, New Haven, Conn.; the Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland; the Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Alberta; the Departments of Psychiatry and Biobehavioral
  • Seidman LJ; From the Departments of Psychology and Psychiatry, Yale University, New Haven, Conn.; the Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland; the Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Alberta; the Departments of Psychiatry and Biobehavioral
  • Tsuang MT; From the Departments of Psychology and Psychiatry, Yale University, New Haven, Conn.; the Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland; the Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Alberta; the Departments of Psychiatry and Biobehavioral
  • Walker EF; From the Departments of Psychology and Psychiatry, Yale University, New Haven, Conn.; the Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland; the Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Alberta; the Departments of Psychiatry and Biobehavioral
  • Woods SW; From the Departments of Psychology and Psychiatry, Yale University, New Haven, Conn.; the Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland; the Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Alberta; the Departments of Psychiatry and Biobehavioral
  • Kattan MW; From the Departments of Psychology and Psychiatry, Yale University, New Haven, Conn.; the Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland; the Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Alberta; the Departments of Psychiatry and Biobehavioral
Am J Psychiatry ; 173(10): 980-988, 2016 Oct 01.
Article em En | MEDLINE | ID: mdl-27363508
ABSTRACT

OBJECTIVE:

Approximately 20%-35% of individuals 12-35 years old who meet criteria for a prodromal risk syndrome convert to psychosis within 2 years. However, this estimate ignores the fact that clinical high-risk cases vary considerably in risk. The authors sought to create a risk calculator, based on profiles of risk indicators, that can ascertain the probability of conversion to psychosis in individual patients.

METHOD:

The study subjects were 596 clinical high-risk participants from the second phase of the North American Prodrome Longitudinal Study who were followed up to the time of conversion to psychosis or last contact (up to 2 years). The predictors examined were limited to those that are supported by previous studies and are readily obtainable in general clinical settings. Time-to-event regression was used to build a multivariate model predicting conversion, with internal validation using 1,000 bootstrap resamples.

RESULTS:

The 2-year probability of conversion to psychosis was 16%. Higher levels of unusual thought content and suspiciousness, greater decline in social functioning, lower verbal learning and memory performance, slower speed of processing, and younger age at baseline each contributed to individual risk for psychosis. Stressful life events, trauma, and family history of schizophrenia were not significant predictors. The multivariate model achieved a concordance index of 0.71 and, as reported in an article by Carrión et al., published concurrently with this one, was validated in an independent external data set. The results are instantiated in a web-based risk prediction tool envisioned to be most useful in research protocols involving the psychosis prodrome.

CONCLUSIONS:

A risk calculator comparable in accuracy to those for cardiovascular disease and cancer is available to predict individualized conversion risks in newly ascertained clinical high-risk cases. Given that the risk calculator can be validly applied only for patients who screen positive on the Structured Clinical Interview for Psychosis Risk Syndromes, which requires training to administer, its most immediate uses will be in research on psychosis risk factors and in research-driven clinical (prevention) trials.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Transtornos Psicóticos / Valor Preditivo dos Testes / Sintomas Prodrômicos Tipo de estudo: Clinical_trials / Diagnostic_studies / Etiology_studies / Guideline / Observational_studies / Prognostic_studies / Qualitative_research / Risk_factors_studies / Screening_studies Limite: Adolescent / Humans Idioma: En Revista: Am J Psychiatry Ano de publicação: 2016 Tipo de documento: Article
Texto completo
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Transtornos Psicóticos / Valor Preditivo dos Testes / Sintomas Prodrômicos Tipo de estudo: Clinical_trials / Diagnostic_studies / Etiology_studies / Guideline / Observational_studies / Prognostic_studies / Qualitative_research / Risk_factors_studies / Screening_studies Limite: Adolescent / Humans Idioma: En Revista: Am J Psychiatry Ano de publicação: 2016 Tipo de documento: Article