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Development of a stage-dependent prognostic model to predict psychosis in ultra-high-risk patients seeking treatment for co-morbid psychiatric disorders

Published online by Cambridge University Press:  16 March 2016

H. K. Ising ,
S. Ruhrmann ,
N. A. F. M. Burger ,
J. Rietdijk ,
S. Dragt ,
R. M. C. Klaassen ,
D. P. G. van den Berg ,
D. H. Nieman ,
N. Boonstra  and
D. H. Linszen
...Show all authors
H. K. Ising*
Affiliation:
Department of Psychiatry, Parnassia Psychiatric Institute, The Hague, The Netherlands
S. Ruhrmann
Affiliation:
Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
N. A. F. M. Burger
Affiliation:
Department of Psychiatry, Parnassia Psychiatric Institute, The Hague, The Netherlands
J. Rietdijk
Affiliation:
Department of Psychiatry, Parnassia Psychiatric Institute, The Hague, The Netherlands VU University and EMGO+, Institute of Health and Care Research, Amsterdam, The Netherlands
S. Dragt
Affiliation:
Department of Psychiatry, Academic Medical Center, Amsterdam, The Netherlands
R. M. C. Klaassen
Affiliation:
Child and Adolescent Department, University Medical Centre, Utrecht, The Netherlands
D. P. G. van den Berg
Affiliation:
Department of Psychiatry, Parnassia Psychiatric Institute, The Hague, The Netherlands
D. H. Nieman
Affiliation:
Department of Psychiatry, Academic Medical Center, Amsterdam, The Netherlands
N. Boonstra
Affiliation:
Department of Education and Research, GGZ Friesland, Leeuwarden, The Netherlands
D. H. Linszen
Affiliation:
Department of Psychiatry, Academic Medical Center, Amsterdam, The Netherlands
L. Wunderink
Affiliation:
Department of Education and Research, GGZ Friesland, Leeuwarden, The Netherlands
F. Smit
Affiliation:
VU University and EMGO+, Institute of Health and Care Research, Amsterdam, The Netherlands Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands Department of Public Mental Health, Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands
W. Veling
Affiliation:
Department of Psychiatry, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands
M. van der Gaag
Affiliation:
Department of Psychiatry, Parnassia Psychiatric Institute, The Hague, The Netherlands VU University and EMGO+, Institute of Health and Care Research, Amsterdam, The Netherlands
*
*Address for correspondence: H. Ising, MSc, Department of Psychiatry, Parnassia Psychiatric Institute, Zoutkeetsingel 40, 2512 HN The Hague, The Netherlands. (Email: h.ising@parnassia.nl)
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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 14–35 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 ⩾8 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.

Keywords

Distressnegative symptomsprognostic indexpsychosis predictionrisk stratificationsocial functioningultra-high risk
Type
Original Articles
Information
Psychological Medicine , Volume 46 , Issue 9 , July 2016 , pp. 1839 - 1851
Copyright
Copyright © Cambridge University Press 2016 

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