Prediction of psychosis in youth at high clinical risk
Prediction of psychosis in youth at high clinical risk
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DOI：
10.1001/archgenpsychiatry.2007.3
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发表时间：
2008-01-01
影响因子：
--
通讯作者：
Heinssen, Robert
中科院分区：
文献类型：
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作者：
Cannon, Tyrone D.;Cadenhead, Kristin;Heinssen, Robert
背景：早期发现和前瞻性评估将发展为精神分裂症或其他精神障碍的个体对于努力分离精神疾病发病机制和预防性干预措施的测试至关重要，但现有的风险预测方法仅实现了适度的预测准确性。目的：确定转化为精神病的风险，并评估一套在临床高危样本中最大化阳性预测能力的预测算法。设计、环境和参与者：对291名符合前驱综合征结构化访谈标准的前瞻性寻求治疗的患者进行为期2年半的纵向随访研究。作为北美前驱期纵向研究的一部分，这些患者被招募并在8个临床研究中心接受评估。主要结果测量：转化为完全精神病形式的精神疾病的时间。结果：在2年半的随访中，转换为精神病的风险为35%，转换率下降。基线评估的五个特征对精神病的预测有独特的贡献：精神分裂症的遗传风险，近期功能恶化，更高水平的异常思维内容，更高水平的怀疑/偏执，更大的社会障碍，以及药物滥用史。与单独的前驱症状标准相比，结合2或3个变量的预测算法导致阳性预测能力显著提高（即68%，80%）。结论：这些发现表明，对精神病风险个体的前瞻性确定是可行的，其预测准确度水平与其他预防医学领域相当。他们为精神病风险函数的比率和形状提供了一个基准，标准化的预防干预方案可以与之比较。
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 1/2-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 1/2year 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.