Universität zu Köln

Ising, H. K., Ruhrmann, S., Burger, N. A. F. M., Rietdijk, J., Dragt, S., Klaassen, R. M. C., van den Berg, D. P. G., Nieman, D. H., Boonstra, N., Linszen, D. H., Wunderink, L., Smit, F., Veling, W. and van der Gaag, M. (2016). Development of a stage-dependent prognostic model to predict psychosis in ultra-high-risk patients seeking treatment for co-morbid psychiatric disorders. Psychol. Med., 46 (9). S. 1839 - 1852. NEW YORK: CAMBRIDGE UNIV PRESS. ISSN 1469-8978

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Abstract

Background. Current ultra-high-risk (UHR) criteria appear insufficient to predict imminent onset of first-episode psychosis, as a meta-analysis showed that about 20% of patients have a psychotic outcome after 2 years. Therefore, we aimed to develop a stage-dependent predictive model in UHR individuals who were seeking help for co-morbid disorders. Method. Baseline data on symptomatology, and environmental and psychological factors of 185 UHR patients (aged 1435 years) participating in the Dutch Early Detection and Intervention Evaluation study were analysed with Cox proportional hazard analyses. Results. At 18 months, the overall transition rate was 17.3%. The final predictor model included five variables: observed blunted affect [hazard ratio (HR) 3.39, 95% confidence interval (CI) 1.56-7.35, p < 0.001], subjective complaints of impaired motor function (HR 5.88, 95% CI 1.21-6.10, p = 0.02), beliefs about social marginalization (HR 2.76, 95% CI 1.14-6.72, p = 0.03), decline in social functioning (HR 1.10, 95% CI 1.01-1.17, p = 0.03), and distress associated with suspiciousness (HR 1.02, 95% CI 1.00-1.03, p = 0.01). The positive predictive value of the model was 80.0%. The resulting prognostic index stratified the general risk into three risk classes with significantly different survival curves. In the highest risk class, transition to psychosis emerged on average 58 months earlier than in the lowest risk class. Conclusions. Predicting a first-episode psychosis in help-seeking UHR patients was improved using a stage-dependent prognostic model including negative psychotic symptoms (observed flattened affect, subjective impaired motor functioning), impaired social functioning and distress associated with suspiciousness. Treatment intensity may be stratified and personalized using the risk stratification.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Ising, H. K. UNSPECIFIED UNSPECIFIED UNSPECIFIED Ruhrmann, S. UNSPECIFIED UNSPECIFIED UNSPECIFIED Burger, N. A. F. M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Rietdijk, J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Dragt, S. UNSPECIFIED UNSPECIFIED UNSPECIFIED Klaassen, R. M. C. UNSPECIFIED UNSPECIFIED UNSPECIFIED van den Berg, D. P. G. UNSPECIFIED UNSPECIFIED UNSPECIFIED Nieman, D. H. UNSPECIFIED UNSPECIFIED UNSPECIFIED Boonstra, N. UNSPECIFIED UNSPECIFIED UNSPECIFIED Linszen, D. H. UNSPECIFIED UNSPECIFIED UNSPECIFIED Wunderink, L. UNSPECIFIED UNSPECIFIED UNSPECIFIED Smit, F. UNSPECIFIED UNSPECIFIED UNSPECIFIED Veling, W. UNSPECIFIED UNSPECIFIED UNSPECIFIED van der Gaag, M. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-271149
DOI:	10.1017/S0033291716000325
Journal or Publication Title:	Psychol. Med.
Volume:	46
Number:	9
Page Range:	S. 1839 - 1852
Date:	2016
Publisher:	CAMBRIDGE UNIV PRESS
Place of Publication:	NEW YORK
ISSN:	1469-8978
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language COGNITIVE-BEHAVIORAL THERAPY; RANDOMIZED CONTROLLED-TRIAL; HIGH-CLINICAL-RISK; AT-RISK; FOLLOW-UP; PSYCHOMETRIC PROPERTIES; TRANSITION-OUTCOMES; PRODROMAL CRITERIA; MENTAL STATES; YOUNG-PEOPLE Multiple languages Psychology, Clinical; Psychiatry; Psychology Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/27114