Hostname: page-component-586b7cd67f-t8hqh Total loading time: 0 Render date: 2024-11-24T14:58:29.708Z Has data issue: false hasContentIssue false
  • English
  • Français

Recency and intensification of positive symptoms enhance prediction of conversion to syndromal psychosis in clinical high-risk patients

Published online by Cambridge University Press:  29 October 2019

Gary Brucato ,
Michael B. First ,
Gabriella A. Dishy ,
Shana S. Samuel ,
Qing Xu ,
Melanie M. Wall ,
Scott A. Small ,
Michael D. Masucci ,
Jeffrey A. Lieberman  and
Ragy R. Girgis Open the ORCID record for Ragy R. Girgis [Opens in a new window]
Gary Brucato
Affiliation:
Department of Psychiatry, The Center of Prevention & Evaluation (COPE), Columbia University College of Physicians & Surgeons, Columbia University Medical Center, New York State Psychiatric Institute, NY, USA
Michael B. First
Affiliation:
Columbia University College of Physicians & Surgeons, Columbia University Medical Center, New York State Psychiatric Institute, NY, USA
Gabriella A. Dishy
Affiliation:
New York State Psychiatric Institute, NY, USA
Shana S. Samuel
Affiliation:
New York State Psychiatric Institute, NY, USA
Qing Xu
Affiliation:
New York State Psychiatric Institute, NY, USA
Melanie M. Wall
Affiliation:
Columbia University College of Physicians & Surgeons, Columbia University Medical Center, New York State Psychiatric Institute, NY, USA
Scott A. Small
Affiliation:
Alzheimer's Disease Research Center, Departments of Neurology, Psychiatry, Radiology, Columbia University, NY, USA
Michael D. Masucci
Affiliation:
New York State Psychiatric Institute, NY, USA
Jeffrey A. Lieberman
Affiliation:
Columbia University, Vagelos College of Physicians and Surgeons, Director, New York State Psychiatric Institute Psychiatrist-in-Chief, New York Presbyterian Hospital-Columbia University Medical Center, NY, USA
Ragy R. Girgis*
Affiliation:
Department of Psychiatry, College of Physicians and Surgeons, Columbia University, and New York> State Psychiatric Institute, NY, USA
*
Author for correspondence: Ragy R. Girgis, E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Early detection and intervention strategies in patients at clinical high-risk (CHR) for syndromal psychosis have the potential to contain the morbidity of schizophrenia and similar conditions. However, research criteria that have relied on severity and number of positive symptoms are limited in their specificity and risk high false-positive rates. Our objective was to examine the degree to which measures of recency of onset or intensification of positive symptoms [a.k.a., new or worsening (NOW) symptoms] contribute to predictive capacity.

Methods

We recruited 109 help-seeking individuals whose symptoms met criteria for the Progression Subtype of the Attenuated Positive Symptom Psychosis-Risk Syndrome defined by the Structured Interview for Psychosis-Risk Syndromes and followed every three months for two years or onset of syndromal psychosis.

Results

Forty-one (40.6%) of 101 participants meeting CHR criteria developed a syndromal psychotic disorder [mostly (80.5%) schizophrenia] with half converting within 142 days (interquartile range: 69–410 days). Patients with more NOW symptoms were more likely to convert (converters: 3.63 ± 0.89; non-converters: 2.90 ± 1.27; p = 0.001). Patients with stable attenuated positive symptoms were less likely to convert than those with NOW symptoms. New, but not worsening, symptoms, in isolation, also predicted conversion.

Conclusions

Results suggest that the severity and number of attenuated positive symptoms are less predictive of conversion to syndromal psychosis than the timing of their emergence and intensification. These findings also suggest that the earliest phase of psychotic illness involves a rapid, dynamic process, beginning before the syndromal first episode, with potentially substantial implications for CHR research and understanding the neurobiology of psychosis.

Keywords

Clinical high riskconversionnewpsychosisschizophreniastructured interview for psychosis risk syndromesworsening
Type
Original Articles
Information
Psychological Medicine , Volume 51 , Issue 1 , January 2021 , pp. 112 - 120
Check for updates
Copyright
Copyright © Cambridge University Press 2019

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Addington, J, Liu, L, Buchy, L, Cadenhead, KS, Cannon, TD, Cornblatt, BA, Perkins, DO, Seidman, LJ, Tsuang, MT, Walker, EF, Woods, SW, Bearden, CE, Mathalon, DH and McGlashan, TH (2015) North American prodrome Longitudinal Study (NAPLS-2): the prodromal symptoms. The Journal of Nervous and Mental Disease 203, 328–335.CrossRefGoogle ScholarPubMed
American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders. Washington, DC: American Psychiatric Association.Google Scholar
Brucato, G, Masucci, MD, Arndt, LY, Ben-David, S, Colibazzi, T, Corcoran, CM, Crumbley, AH, Crump, FM, Gill, KE, Kimhy, D, Lister, A, Schobel, SA, Yang, LH, Lieberman, JA and Girgis, RR (2017) Baseline demographics, clinical features and predictors of conversion among 200 individuals in a longitudinal prospective psychosis-risk cohort. Psychological Medicine 47, 1923–1935.CrossRefGoogle Scholar
Cannon, TD, Yu, C, Addington, J, Bearden, CE, Cadenhead, KS, Cornblatt, BA, Heinssen, R, Jeffries, CD, Mathalon, DH, McGlashan, TH, Perkins, DO, Seidman, LJ, Tsuang, MT, Walker, EF, Woods, SW and Kattan, MW (2016) An individualized risk calculator for research in prodromal psychosis. American Journal of Psychiatry 173, 980–988.CrossRefGoogle ScholarPubMed
Ciarleglio, AJ, Brucato, G, Masucci, MD, Altschuler, R, Colibazzi, T, Corcoran, CM, Crump, FM, Horga, G, Lehembre-Shiah, E, Leong, W, Schobel, SA, Wall, MM, Yang, LH, Lieberman, JA and Girgis, RR (2019) A predictive model for conversion to psychosis in clinical high-risk patients. Psychoogicall Medicine 49, 1128–1137.CrossRefGoogle ScholarPubMed
Cornblatt, BA, Auther, AM, Niendam, T, Smith, CW, Zinberg, J, Bearden, CE and Cannon, TD (2007) Preliminary findings for two new measures of social and role functioning in the prodromal phase of schizophrenia. Schizophrenia Bulletin 33, 688–702.CrossRefGoogle ScholarPubMed
Cornblatt, BA, Carrion, RE, Auther, A, McLaughlin, D, Olsen, RH, John, M and Correll, CU (2015) Psychosis prevention: a modified clinical high risk perspective from the recognition and prevention (RAP) program. American Journal of Psychiatry 172, 986–994.CrossRefGoogle ScholarPubMed
Correll, CU, Hauser, MH, Auther, AM and Cornblatt, BA (2010) Research in people with the psychosis risk syndrome: a review of the current evidence and future directions. Journal of Child Psychology and Psychiatry 51, 390–431.CrossRefGoogle ScholarPubMed
Crump, FM, Arndt, L, Grivel, M, Horga, G, Corcoran, CM, Brucato, G and Girgis, RR (2018) Attenuated first-rank symptoms and conversion to psychosis in a clinical high-risk cohort. Early Intervention in Psychiatry 12, 1213–1216.CrossRefGoogle Scholar
First, MB, Spitzer, RL, Gibbon, M and Williams, JBW (1996) Structured Clinical Interview for DSM-IV Axis I Disorders, Clinician Version (SCID-CV). Washington, DC: American Psychiatric Press, Inc.Google Scholar
First, MB, Williams, JBW, Karg, RS and Spitzer, RL (2015) Structured Clinical Interview for DSM-5 Disorders, Clinical Trials Version (SCID-5-CT). Arlington, VA: American Psychiatric Association.Google Scholar
Fusar-Poli, P, Borgwardt, S, Bechdolf, A, Addington, J, Richer-Rossler, A, Schultze-Lutter, F, Keshavan, M, Wood, S, Ruhrmann, S, Seidman, LJ, Valmaggia, L, Cannon, T, Velthorst, E, De Haan, L, Cornblatt, B, Bonoldi, I, Birchwood, M, McGlashan, T, Carpenter, W, McGorry, P, Klosterkotter, J, McGuire, P and Yung, A (2013) The psychosis high-risk state: a comprehensive state-of-the-art review. JAMA Psychiatry 70, 107–120.CrossRefGoogle ScholarPubMed
Fusar-Poli, P, Rutigliano, G, Stahl, D, Davies, C, Bonoldi, I, Reilly, T and McGuire, P (2017) Development and validation of a clinically based risk calculator for the transdiagnostic prediction of psychosis. JAMA Psychiatry 74, 493–500.CrossRefGoogle ScholarPubMed
Hawkins, KA, Quinlan, D, Miller, TJ, Woods, SW, Zipursky, RB, Perkins, DO, Addington, J and McGlashan, TH (2004) Factorial structure of the scale of prodromal symptoms. Schizophrenia Research 68, 339–347.CrossRefGoogle ScholarPubMed
IBM Corporation (2013) IBM SPSS Statistics for Windows, Version 22.0. IBM Corporation Armonk, NY.Google Scholar
Lehembre-Shiah, E, Leong, W, Brucato, G, Abi-Dargham, A, Lieberman, JA, Horga, G and Girgis, RR (2017) Distinct relationships between visual and auditory perceptual abnormalities and conversion to psychosis in a clinical high-risk population. JAMA Psychiatry 74, 104–106.CrossRefGoogle Scholar
Lieberman, JA, Alvir, JM, Koreen, A, Geisler, S, Chakos, M, Sheitman, B and Woerner, M (1996) Psychobiologic correlates of treatment response in schizophrenia. Neuropsychopharmacology 14, 13S–21S.CrossRefGoogle Scholar
McGlashan, TH, Miller, TJ, Woods, SW, Hoffman, RE and Davidson, LA (2001) Scale for the assessment of prodromal symptoms and states. In Miller, T, Mednick, SA, McGlashan, TH, Liberger, J and Johannessen, JO (eds), Early Intervention in Psychotic Disorders. Dordrecht, The Netherlands: Kluwer Academic Publishers, pp. 135–149.CrossRefGoogle Scholar
McGlashan, TH, Walsh, BC and Woods, SW (2014) Structured interview for psychosis-risk syndromes, English language (version 5.6) PRIME Research Clinic, Yale School of Medicine: New Haven, CT.Google Scholar
Miller, TJ, McGlashan, TH, Woods, SW, Stein, K, Driesen, N, Corcoran, CM, Hoffman, R and Davidson, L (1999) Symptom assessment in schizophrenic prodromal states. Psychiatric Quarterly 70, 273–287.CrossRefGoogle ScholarPubMed
Miller, TJ, McGlashan, TH, Rosen, JL, Somjee, L, Markovich, PJ, Stein, K and Woods, SW (2002) Prospective diagnosis of the prodrome for schizophrenia: preliminary evidence of interrater reliability and predictive validity using operational criteria and a structured interview. American Journal of Psychiatry 159, 863–865.CrossRefGoogle Scholar
Miller, TJ, McGlashan, TH, Rosen, JL, Cadenhead, K, Cannon, T, Ventura, J, McFarlane, W, Perkins, DO, Pearlson, GD and Woods, SW (2003) Prodromal assessment with the structured interview for prodromal syndromes and the scale of prodromal symptoms: predictive validity, interrater reliability, and training to reliability. Schizophrenia Bulletin 29, 703–715.CrossRefGoogle ScholarPubMed
Nurnberger, JI Jr, Blehar, MC, Kaufmann, CA, York-Cooler, C, Simpson, SG, Harkavy-Friedman, J, Severe, JB, Malaspina, D and Reich, T (1994) Diagnostic interview for genetic studies. Rationale, unique features, and training. NIMH genetics initiative. Archives of General Psychiatry 51, 849–859, discussion 863-4.CrossRefGoogle ScholarPubMed
Perkins, DO, Gu, H, Boteva, K and Lieberman, JA (2005) Relationship between duration of untreated psychosis and outcome in first-episode schizophrenia: a critical review and meta-analysis. American Journal of Psychiatry 162, 1785–1804.CrossRefGoogle ScholarPubMed
Perkins, DO, Jeffries, CD, Cornblatt, BA, Woods, SW, Addington, J, Bearden, CE, Cadenhead, KS, Cannon, TD, Heinssen, R, Mathalon, DH, Seidman, LJ, Tsuang, MT, Walker, EF and McGlashan, TH (2015) Severity of thought disorder predicts psychosis in persons at clinical high-risk. Schizophrenia Research 169, 169–177.CrossRefGoogle ScholarPubMed
Rosen, JL, Woods, SW, Miller, TJ and McGlashan, TH (2002) Prospective observations of emerging psychosis. Journal of Nervous and Mental Disease 190, 133–141.CrossRefGoogle ScholarPubMed
Schultze-Lutter, F, Michel, C, Ruhrmann, S and Schimmelmann, BG (2014) Prevalence and clinical significance of DSM-5-attenuated psychosis syndrome in adolescents and young adults in the general population: the Bern Epidemiological At-Risk (BEAR) study. Schizophrenia Bulletin 40, 1499–1508.CrossRefGoogle Scholar
Wyatt, RJ (1991) Neuroleptics and the natural course of schizophrenia. Schizophrenia Bulletin 17, 325–351.CrossRefGoogle ScholarPubMed
Yang, LH, Link, BG, Ben-David, S, E, GK, Girgis, RR, Brucato, G, Wonpat-Borja, AJ and Corcoran, CM (2015) Stigma related to labels and symptoms in individuals at clinical high-risk for psychosis. Schizophrenia Research 168, 9–15.CrossRefGoogle ScholarPubMed
Yung, AR, Phillips, LJ, Yuen, HP, Francey, SM, McFarlane, CA, Hallgren, M and McGorry, PD (2003) Psychosis prediction: 12-month follow up of a high-risk (“prodromal”) group. Schizophrenia Research 60, 21–32.CrossRefGoogle ScholarPubMed
Yung, AR, Yuen, HP, Berger, G, Francey, S, Hung, TC, Nelson, B, Phillips, L and McGorry, P (2007) Declining transition rate in ultra high risk (prodromal) services: dilution or reduction of risk? Schizophrenia Bulletin 33, 673–681.CrossRefGoogle ScholarPubMed
Supplementary material: File

Brucato et al. supplementary material

Tables S1-S5

Download Brucato et al. supplementary material(File)
File 21.8 KB