Predictive validity of conversion from the clinical high risk syndrome to frank psychosis

• Type of Material: Article
• Authors: Laura A. Yoviene Sykes, Yale University; Maria Ferrara, Yale University; Jean Addington, University of Calgary; Carrie E. Bearden, University of California, Los Angeles; Kristin S. Cadenhead, University of California San Diego; Tyrone D. Cannon, Yale University; Barbara A. Cornblatt, The Zucker Hillside Hospital; Diana O. Perkins, University of North Carolina at Chapel Hill; Daniel H. Mathalon, University of California, San Francisco; Larry J. Seidman, Harvard University; Ming T. Tsuang, University of California San Diego; Elaine Walker, Emory University; Thomas H. McGlashan, Yale University; Kristen A. Woodberry, Harvard University; Albert R. Powers, Yale University; Allison N. Ponce, Yale University; John D. Cahill, Yale University; Jessica M. Pollard, Yale University; Vinod H. Srihari, Yale University; Scott W. Woods, Yale University
• Language: English
• Date: 2020-02-01
• Publisher: Elsevier
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2019 Elsevier B.V. All rights reserved.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.schres.2019.12.002
• Title of Journal or Parent Work: Schizophrenia Research
• Volume: 216
• Start Page: 184
• End Page: 191
• Grant/Funding Information: This study was supported by the NIMH (U01MH081984 to JA; U01 MH081928; P50 MH080272; Commonwealth of Massachusetts SCDMH82101008006 to LJS;; grant U01MH081988 to EFW; U01MH082022 to SWW; UO1 MH081857-05 to BAC; and R01 MH103831 to VHS.); R01 MH60720, U01 MH082022, and K24 MH76191 to KSC; U01MH081902 to TDC; P50 MH066286 (Prodromal Core) to CEB; U01MH082004 to DOP;; This work was funded in part by the State of Connecticut, DMHAS, but this publication does not express the views of DMHAS or the State of Connecticut.
• Keywords: Humans; Psychotic Disorders; Syndrome; Prodromal Symptoms; Predictive validity; SIPS; Transition; Longitudinal Studies
• Research Categories: Health Sciences, Mental Health; Psychology, Cognitive; Psychology, Clinical

Abstract

Although the clinical high risk for psychosis (CHR) paradigm has become well-established over the past two decades, one key component has received surprisingly little investigative attention: the predictive validity of the criteria for conversion or transition to frank psychosis. The current study evaluates the predictive validity of the transition to psychosis as measured by the Structured Interview for Psychosis-Risk Syndromes (SIPS) in CHR individuals. Participants included 33 SIPS converters and 399 CHR non-converters both from the North American Prodromal Longitudinal Study (NAPLS-2), as well as a sample of 67 separately ascertained first-episode psychosis (FEP) patients from the STEP program. Comparisons were made at baseline and one-year follow-up on demographic, diagnostic stability (SCID), and available measurement domains relating to severity of illness (psychotropic medication, psychosocial treatment, and resource utilization). Principal findings are: 1) a large majority of cases in both SIPS converters (n = 27/33, 81.8%) and FEP (n = 57/67, 85.1%) samples met criteria for continued psychosis at one-year follow-up; 2) follow-up prescription rates for current antipsychotic medication were higher in SIPS converters (n = 17/32, 53.1%) compared to SIPS non-converters (n = 81/397, 20.4%), and similar as compared to FEP cases (n = 39/65, 60%); and 3) at follow-up, SIPS converters had higher rates of resource utilization (psychiatric hospitalizations, day hospital admissions, and ER visits) than SIPS non-converters and were similar to FEP in most categories. The results suggest that the SIPS definition of psychosis onset carries substantial predictive validity. Limitations and future directions are discussed.