title: Development of a stage-dependent prognostic model to predict psychosis in ultra-high-risk patients seeking treatment for co-morbid psychiatric disorders.
abstract: Current ultra-high-risk (UHR) criteria appear insufficient to predict imminent onset of first-episode psychosis, as a meta-analysis showed that about 20% of patients have a psychotic outcome after 2 years. Therefore, we aimed to develop a stage-dependent predictive model in UHR individuals who were seeking help for co-morbid disorders.
  
  
  
  Baseline data on symptomatology, and environmental and psychological factors of 185 UHR patients (aged 14-35 years) participating in the Dutch Early Detection and Intervention Evaluation study were analysed with Cox proportional hazard analyses.
  
  
  
  At 18 months, the overall transition rate was 17.3%. The final predictor model included five variables: observed blunted affect [hazard ratio (HR) 3.39, 95% confidence interval (CI) 1.56-7.35, p < 0.001], subjective complaints of impaired motor function (HR 5.88, 95% CI 1.21-6.10, p = 0.02), beliefs about social marginalization (HR 2.76, 95% CI 1.14-6.72, p = 0.03), decline in social functioning (HR 1.10, 95% CI 1.01-1.17, p = 0.03), and distress associated with suspiciousness (HR 1.02, 95% CI 1.00-1.03, p = 0.01). The positive predictive value of the model was 80.0%. The resulting prognostic index stratified the general risk into three risk classes with significantly different survival curves. In the highest risk class, transition to psychosis emerged on average ⩾8 months earlier than in the lowest risk class.
  
  
  
  Predicting a first-episode psychosis in help-seeking UHR patients was improved using a stage-dependent prognostic model including negative psychotic symptoms (observed flattened affect, subjective impaired motor functioning), impaired social functioning and distress associated with suspiciousness. Treatment intensity may be stratified and personalized using the risk stratification.
authors.affiliation: Department of Psychiatry,Parnassia Psychiatric Institute,The Hague,The Netherlands.
authors.forename: H K
authors.initials: HK
authors.lastname: Ising
authors.affiliation: Department of Psychiatry and Psychotherapy,University of Cologne,Cologne,Germany.
authors.forename: S
authors.initials: S
authors.lastname: Ruhrmann
authors.affiliation: Department of Psychiatry,Parnassia Psychiatric Institute,The Hague,The Netherlands.
authors.forename: N A F M
authors.initials: NA
authors.lastname: Burger
authors.affiliation: Department of Psychiatry,Parnassia Psychiatric Institute,The Hague,The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Rietdijk
authors.affiliation: Department of Psychiatry,Academic Medical Center,Amsterdam,The Netherlands.
authors.forename: S
authors.initials: S
authors.lastname: Dragt
authors.affiliation: Child and Adolescent Department,University Medical Centre,Utrecht,The Netherlands.
authors.forename: R M C
authors.initials: RM
authors.lastname: Klaassen
authors.affiliation: Department of Psychiatry,Parnassia Psychiatric Institute,The Hague,The Netherlands.
authors.forename: D P G
authors.initials: DP
authors.lastname: van den Berg
authors.affiliation: Department of Psychiatry,Academic Medical Center,Amsterdam,The Netherlands.
authors.forename: D H
authors.initials: DH
authors.lastname: Nieman
authors.affiliation: Department of Education and Research,GGZ Friesland,Leeuwarden,The Netherlands.
authors.forename: N
authors.initials: N
authors.lastname: Boonstra
authors.affiliation: Department of Psychiatry,Academic Medical Center,Amsterdam,The Netherlands.
authors.forename: D H
authors.initials: DH
authors.lastname: Linszen
authors.affiliation: Department of Education and Research,GGZ Friesland,Leeuwarden,The Netherlands.
authors.forename: L
authors.initials: L
authors.lastname: Wunderink
authors.affiliation: VU University and EMGO+, Institute of Health and Care Research,Amsterdam,The Netherlands.
authors.forename: F
authors.initials: F
authors.lastname: Smit
authors.affiliation: Department of Psychiatry,University Medical Center Groningen and University of Groningen,Groningen,The Netherlands.
authors.forename: W
authors.initials: W
authors.lastname: Veling
authors.affiliation: Department of Psychiatry,Parnassia Psychiatric Institute,The Hague,The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: van der Gaag
mesh_terms: D000293:Adolescent; D000328:Adult; D015897:Comorbidity; D005500:Follow-Up Studies; D006801:Humans; D001523:Mental Disorders / Q000453:epidemiology / Q000628:therapy*; D015233:Models, Statistical; D011379:Prognosis; D011618:Psychotic Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology*; D012306:Risk; D055815:Young Adult
keywords: Distress; negative symptoms; prognostic index; psychosis prediction; risk stratification; social functioning; ultra-high risk