title: Psychosis prediction in secondary mental health services. A broad, comprehensive approach to the "at risk mental state" syndrome.
abstract: Accuracy of risk algorithms for psychosis prediction in "at risk mental state" (ARMS) samples may differ according to the recruitment setting. Standardized criteria used to detect ARMS individuals may lack specificity if the recruitment setting is a secondary mental health service. The authors tested a modified strategy to predict psychosis conversion in this setting by using a systematic selection of trait-markers of the psychosis prodrome in a sample with a heterogeneous ARMS status.
  
  
  
  138 non-psychotic outpatients (aged 17-31) were consecutively recruited in secondary mental health services and followed-up for up to 3 years (mean follow-up time, 2.2 years; SD=0.9). Baseline ARMS status, clinical, demographic, cognitive, and neurological soft signs measures were collected. Cox regression was used to derive a risk index.
  
  
  
  48% individuals met ARMS criteria (ARMS-Positive, ARMS+). Conversion rate to psychosis was 21% for the overall sample, 34% for ARMS+, and 9% for ARMS-Negative (ARMS-). The final predictor model with a positive predictive validity of 80% consisted of four variables: Disorder of Thought Content, visuospatial/constructional deficits, sensory-integration, and theory-of-mind abnormalities. Removing Disorder of Thought Content from the model only slightly modified the predictive accuracy (-6.2%), but increased the sensitivity (+9.5%).
  
  
  
  These results suggest that in a secondary mental health setting the use of trait-markers of the psychosis prodrome may predict psychosis conversion with great accuracy despite the heterogeneity of the ARMS status. The use of the proposed predictive algorithm may enable a selective recruitment, potentially reducing duration of untreated psychosis and improving prognostic outcomes.
authors.affiliation: Department of Neurology and Psychiatry, Sapienza University of Rome, Italy; Department of Psychiatry, UCSD, La Jolla, CA, United States.
authors.forename: M
authors.initials: M
authors.lastname: Francesconi
authors.affiliation: Department of Neurology and Psychiatry, Sapienza University of Rome, Italy; Department of Psychiatry, UCSD, La Jolla, CA, United States. Electronic address: amedeomin@gmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Minichino
authors.affiliation: Division of Psychiatry, Zucker Hillside Hospital, Long Island, NY, United States.
authors.forename: R E
authors.initials: RE
authors.lastname: Carrión
authors.affiliation: Department of Neurology and Psychiatry, Sapienza University of Rome, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Delle Chiaie
authors.affiliation: Research Center in Neurobiology, Daniel Bovet (CRiN), Rome, Italy; Department of Psychology, Section of Neuroscience, Sapienza University of Rome, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Bevilacqua
authors.affiliation: Villa Armonia Nuova, Rome, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Parisi
authors.affiliation: Casa di Cura Villa Letizia, Rome, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Rullo
authors.affiliation: Department of Neurology and Psychiatry, Sapienza University of Rome, Italy.
authors.forename: F Saverio
authors.initials: FS
authors.lastname: Bersani
authors.affiliation: Department of Neurology and Psychiatry, Sapienza University of Rome, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Biondi
authors.affiliation: Department of Psychiatry, UCSD, La Jolla, CA, United States.
authors.forename: K
authors.initials: K
authors.lastname: Cadenhead
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008603:Mental Health; D008605:Mental Health Services; D011379:Prognosis; D011618:Psychotic Disorders / Q000523:psychology* / Q000628:therapy*; D012306:Risk; D018570:Risk Assessment; D055815:Young Adult
keywords: Clinical high risk; Neurocognition; Neurological soft signs; Theory of mind; Ultra high risk