title: Environmental factors and social adjustment as predictors of a first psychosis in subjects at ultra high risk.
abstract: BACKGROUND
  The onset of schizophrenia is associated with genetic, symptomatic, social and environmental risk factors. The aim of the present study was to determine which environmental factors may contribute to a prediction of a first psychotic episode in subjects at Ultra High Risk (UHR) for developing psychosis.
  
  
  METHODS
  We included 72 UHR subjects and followed them over a period of 36 months, of whom nineteen (26.4%) made a transition to psychosis. We applied survival analyses to determine associations between a transition to psychosis and environmental factors and social adjustment. To determine which items are the best predictors of transition to a first psychotic episode, Cox Regression analyses were applied.
  
  
  RESULTS
  Urbanicity, receiving state benefits and poor premorbid adjustment (PMA) significantly influenced the transition to psychosis. Urbanicity (Wald=10.096, p=.001, HR=30.97), social-sexual aspects (Wald=8.795, p=.003, HR=1.91) and social-personal adjustment (Wald=10.794, p=.001, HR=4.26) appeared to be predictors for developing psychosis in our UHR group.
  
  
  CONCLUSIONS
  Environmental characteristics and social adjustment are predictive of transition to a psychosis in subjects at UHR. These characteristics should be implemented in a model for prediction of psychosis. Such a model would be more specific than current models and may lead to patient-specific preventive interventions.
authors.affiliation: Department of Psychiatry, Academic Medical Center, Meibergdreef 5, 1105 AZ Amsterdam, The Netherlands. S.Dragt@amc.uva.nl
authors.forename: Sara
authors.initials: S
authors.lastname: Dragt
authors.forename: Dorien H
authors.initials: DH
authors.lastname: Nieman
authors.forename: Doede
authors.initials: D
authors.lastname: Veltman
authors.forename: Hiske E
authors.initials: HE
authors.lastname: Becker
authors.forename: Reinaud
authors.initials: R
authors.lastname: van de Fliert
authors.forename: Lieuwe
authors.initials: L
authors.lastname: de Haan
authors.forename: Don H
authors.initials: DH
authors.lastname: Linszen
mesh_terms: D000293:Adolescent; D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use; D002648:Child; D018450:Disease Progression; D004777:Environment; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000175:diagnosis* / Q000188:drug therapy / Q000523:psychology*; D012307:Risk Factors; D012917:Social Adjustment; D013997:Time Factors; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents