Specificity of Incident Diagnostic Outcomes in Patients at Clinical High Risk for Psychosis.
It is not well established whether the incident outcomes of the clinical high-risk (CHR) syndrome for psychosis are diagnostically specific for psychosis or whether CHR patients also are at elevated risk for a variety of nonpsychotic disorders. We collected 2 samples (NAPLS-1, PREDICT) that contained CHR patients and a control group who responded to CHR recruitment efforts but did not meet CHR criteria on interview (help-seeking comparison patients [HSC]). Incident diagnostic outcomes were defined as the occurrence of a SIPS-defined psychosis or a structured interview diagnosis from 1 of 3 nonpsychotic Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) groups (anxiety, bipolar, or nonbipolar mood disorder), when no diagnosis in that group was present at baseline. Logistic regression revealed that the CHR vs HSC effect did not vary significantly across study for any emergent diagnostic outcome; data from the 2 studies were therefore combined. CHR (n = 271) vs HSC (n = 171) emergent outcomes were: psychosis 19.6% vs 1.8%, bipolar disorders 1.1% vs 1.2%, nonbipolar mood disorders 4.4% vs 5.3%, and anxiety disorders 5.2% vs 5.3%. The main effect of CHR vs HSC was statistically significant (OR = 13.8, 95% CI 4.2-45.0, df = 1, P < .001) for emergent psychosis but not for any emergent nonpsychotic disorder. Sensitivity analyses confirmed these findings. Within the CHR group emergent psychosis was significantly more likely than each nonpsychotic DSM-IV emergent disorder, and within the HSC group emergent psychosis was significantly less likely than most emergent nonpsychotic disorders. The CHR syndrome is specific as a marker for research on predictors and mechanisms of developing psychosis.
Child Study Center, Yale University, New Haven, CT;
Jadon R
JR
Webb
Department of Psychiatry, University of Calgary, Calgary, Canada;
Jean
J
Addington
Department of Psychiatry, University of North Carolina, Chapel Hill, NC;
Diana O
DO
Perkins
Departments of Psychology and Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA;
Carrie E
CE
Bearden
Department of Psychiatry, UCSD, San Diego, CA;
Kristin S
KS
Cadenhead
Departments of Psychology and Psychiatry, Yale University, New Haven, CT;
Tyrone D
TD
Cannon
Department of Psychiatry, Zucker Hillside Hospital, Long Island, NY;
Barbara A
BA
Cornblatt
Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, MD;
Robert K
RK
Heinssen
Department of Psychiatry, Harvard Medical School, Boston, MA;
Larry J
LJ
Seidman
Department of Psychiatry and Connecticut Mental Health Center, Yale University, New Haven, CT;
Sarah I
SI
Tarbox
Department of Psychiatry, UCSD, San Diego, CA; Department of Psychiatry, Harvard Medical School, Boston, MA;
Ming T
MT
Tsuang
Departments of Psychology and Psychiatry, Emory University, Atlanta, GA.
Elaine F
EF
Walker
Department of Psychiatry and Connecticut Mental Health Center, Yale University, New Haven, CT;
Thomas H
TH
McGlashan
Department of Psychiatry and Connecticut Mental Health Center, Yale University, New Haven, CT; scott.woods@yale.edu.
Scott W
SW
Woods
D000293:Adolescent; D000328:Adult; D000341:Affective Disorders, Psychotic / Q000145:classification / Q000175:diagnosis* / Q000453:epidemiology; D001008:Anxiety Disorders / Q000145:classification / Q000175:diagnosis* / Q000453:epidemiology; D001714:Bipolar Disorder / Q000145:classification / Q000175:diagnosis*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D019964:Mood Disorders / Q000145:classification / Q000175:diagnosis* / Q000453:epidemiology; D010342:Patient Acceptance of Health Care; D062706:Prodromal Symptoms; D011618:Psychotic Disorders / Q000145:classification / Q000175:diagnosis* / Q000453:epidemiology; D012306:Risk; D012680:Sensitivity and Specificity; D013577:Syndrome; D055815:Young Adult
anxiety disorder; bipolar disorder; nonbipolar mood disorder; validity