This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (57)  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in this journal  Topic Collections  • Schizophrenia  • Psychiatry, Other  • Public Health  • Substance Abuse/ Alcoholism  • Prognosis/ Outcomes  • Genetics  • Genetic Disorders  • Alert me on articles by topic  Social Bookmarking   What's this?

A Multisite Longitudinal Study in North America

Tyrone D. Cannon, PhD; Kristin Cadenhead, MD; Barbara Cornblatt, PhD; Scott W. Woods, MD; Jean Addington, PhD; Elaine Walker, PhD; Larry J. Seidman, PhD; Diana Perkins, MD; Ming Tsuang, MD; Thomas McGlashan, MD; Robert Heinssen, PhD

Arch Gen Psychiatry. 2008;65(1):28-37.

Context  Early detection and prospective evaluation of individuals who will develop schizophrenia or other psychotic disorders are critical to efforts to isolate mechanisms underlying psychosis onset and to the testing of preventive interventions, but existing risk prediction approaches have achieved only modest predictive accuracy.

Objectives  To determine the risk of conversion to psychosis and to evaluate a set of prediction algorithms maximizing positive predictive power in a clinical high-risk sample.

Design, Setting, and Participants  Longitudinal study with a 2-year follow-up of 291 prospectively identified treatment-seeking patients meeting Structured Interview for Prodromal Syndromes criteria. The patients were recruited and underwent evaluation across 8 clinical research centers as part of the North American Prodrome Longitudinal Study.

Main Outcome Measure  Time to conversion to a fully psychotic form of mental illness.

Results  The risk of conversion to psychosis was 35%, with a decelerating rate of transition during the 2-year follow-up. Five features assessed at baseline contributed uniquely to the prediction of psychosis: a genetic risk for schizophrenia with recent deterioration in functioning, higher levels of unusual thought content, higher levels of suspicion/paranoia, greater social impairment, and a history of substance abuse. Prediction algorithms combining 2 or 3 of these variables resulted in dramatic increases in positive predictive power (ie, 68%-80%) compared with the prodromal criteria alone.

Conclusions  These findings demonstrate that prospective ascertainment of individuals at risk for psychosis is feasible, with a level of predictive accuracy comparable to that in other areas of preventive medicine. They provide a benchmark for the rate and shape of the psychosis risk function against which standardized preventive intervention programs can be compared.

Author Affiliations: Departments of Psychology and Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (Dr Cannon); Departments of Psychiatry, University of California, San Diego (Drs Cadenhead and Tsuang), Zucker Hillside Hospital, Long Island, New York (Dr Cornblatt), Yale University, New Haven, Connecticut (Drs Woods and McGlashan), University of Toronto, Toronto, Ontario, Canada (Dr Addington), Harvard Medical School, Boston, Massachussetts (Drs Seidman and Tsuang), University of North Carolina, Chapel Hill (Dr Perkins); Departments of Psychology and Psychiatry, Emory University, Atlanta, Georgia (Dr Walker); and Schizophrenia Spectrum Disorders Research Program, Division of Adult Translational Research, National Institute of Mental Health, Bethesda, Maryland (Dr Heinssen).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED ARTICLE

Back to the Future: Predicting and Reshaping the Course of Psychotic Disorder
Patrick D. McGorry, Alison R. Yung, Andreas Bechdolf, and Paul Amminger
Arch Gen Psychiatry. 2008;65(1):25-27.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Collaborating to Provide Early-Intervention Services to Persons in England With First-Episode Psychosis
England et al.
Psychiatr. Serv. 2009;60:1484-1488.
ABSTRACT | FULL TEXT  

Association of Pre-Onset Cannabis, Alcohol, and Tobacco Use With Age at Onset of Prodrome and Age at Onset of Psychosis in First-Episode Patients
Compton et al.
Am. J. Psychiatry 2009;166:1251-1257.
ABSTRACT | FULL TEXT  

Affective Dysregulation and Reality Distortion: A 10-Year Prospective Study of Their Association and Clinical Relevance
van Rossum et al.
Schizophr Bull 2009;0:sbp101v1-sbp101.
ABSTRACT | FULL TEXT  

Longitudinal Study of Stressful Life Events and Daily Stressors Among Adolescents at High Risk for Psychotic Disorders
Tessner et al.
Schizophr Bull 2009;0:sbp087v1-sbp087.
ABSTRACT | FULL TEXT  

Differential Targeting of the CA1 Subfield of the Hippocampal Formation by Schizophrenia and Related Psychotic Disorders
Schobel et al.
Arch Gen Psychiatry 2009;66:938-946.
ABSTRACT | FULL TEXT  

Validity of the Prodromal Risk Syndrome for First Psychosis: Findings From the North American Prodrome Longitudinal Study
Woods et al.
Schizophr Bull 2009;35:894-908.
ABSTRACT | FULL TEXT  

Use of Neuroanatomical Pattern Classification to Identify Subjects in At-Risk Mental States of Psychosis and Predict Disease Transition
Koutsouleris et al.
Arch Gen Psychiatry 2009;66:700-712.
ABSTRACT | FULL TEXT  

Are Screening Instruments Valid for Psychotic-Like Experiences? A Validation Study of Screening Questions for Psychotic-Like Experiences Using In-Depth Clinical Interview
Kelleher et al.
Schizophr Bull 2009;0:sbp057v1-sbp057.
ABSTRACT | FULL TEXT  

The Dopamine Hypothesis of Schizophrenia: Version III--The Final Common Pathway
Howes and Kapur
Schizophr Bull 2009;35:549-562.
ABSTRACT | FULL TEXT  

Translating Scientific Opportunity Into Public Health Impact: A Strategic Plan for Research on Mental Illness
Insel
Arch Gen Psychiatry 2009;66:128-133.
ABSTRACT | FULL TEXT  

Efficacy, safety and tolerability of two risperidone dosing regimens in adolescent schizophrenia: double-blind study
Haas et al.
Br. J. Psychiatry 2009;194:158-164.
ABSTRACT | FULL TEXT  

Elevated Striatal Dopamine Function Linked to Prodromal Signs of Schizophrenia
Howes et al.
Arch Gen Psychiatry 2009;66:13-20.
ABSTRACT | FULL TEXT  

Gene-Environment Interaction and Covariation in Schizophrenia: The Role of Obstetric Complications
Mittal et al.
Schizophr Bull 2008;34:1083-1094.
ABSTRACT | FULL TEXT  

Which Environments for G x E? A User Perspective on the Roles of Trauma and Structural Discrimination in the Onset and Course of Schizophrenia
van Zelst
Schizophr Bull 2008;34:1106-1110.
ABSTRACT | FULL TEXT  

Emotion Processing in Persons at Risk for Schizophrenia
Phillips and Seidman
Schizophr Bull 2008;34:888-903.
ABSTRACT | FULL TEXT  

Comparing Genes and Phenomenology in the Major Psychoses: Schizophrenia and Bipolar 1 Disorder
Ivleva et al.
Schizophr Bull 2008;34:734-742.
FULL TEXT  

Basic Symptoms and Ultrahigh Risk Criteria: Symptom Development in the Initial Prodromal State
Schultze-Lutter et al.
Schizophr Bull 2008;0:sbn072v1-sbn072.
ABSTRACT | FULL TEXT  

Back to the Future: Predicting and Reshaping the Course of Psychotic Disorder
McGorry et al.
Arch Gen Psychiatry 2008;65:25-27.
FULL TEXT