title: Diagnostic and Prognostic Significance of Brief Limited Intermittent Psychotic Symptoms (BLIPS) in Individuals at Ultra High Risk.
abstract: Brief Limited Intermittent Psychotic Symptoms (BLIPS) are key inclusion criteria to define individuals at ultra high risk for psychosis (UHR). Their diagnostic and prognostic significance is unclear.
  
  
  
  To address the baseline diagnostic relationship between BLIPS and the ICD-10 categories and examine the longitudinal prognostic impact of clinical and sociodemographic factors.
  
  
  
  Prospective long-term study in UHR individuals meeting BLIPS criteria. Sociodemographic and clinical data, including ICD-10 diagnoses, were automatically drawn from electronic health records and analyzed using Kaplan-Meier failure function (1-survival), Cox regression models, bootstrapping methods, and Receiver Operating Characteristics (ROC) curve.
  
  
  
  Eighty BLIPS were included. At baseline, two-thirds (68%) of BLIPS met the diagnostic criteria for ICD-10 Acute and Transient Psychotic Disorder (ATPD), most featuring schizophrenic symptoms. The remaining individuals met ICD-10 diagnostic criteria for unspecified nonorganic psychosis (15%), mental and behavioral disorders due to use of cannabinoids (11%), and mania with psychotic symptoms (6%). The overall 5-year risk of psychosis was 0.54. Recurrent episodes of BLIPS were relatively rare (11%) but associated with a higher risk of psychosis (hazard ratio [HR] 3.98) than mono-episodic BLIPS at the univariate analysis. Multivariate analysis revealed that seriously disorganizing or dangerous features increased greatly (HR = 4.39) the risk of psychosis (0.89 at 5-year). Bootstrapping confirmed the robustness of this predictor (area under the ROC = 0.74).
  
  
  
  BLIPS are most likely to fulfill the ATPD criteria, mainly acute schizophrenic subtypes. About half of BLIPS cases develops a psychotic disorder during follow-up. Recurrent BLIPS are relatively rare but tend to develop into psychosis. BLIPS with seriously disorganizing or dangerous features have an extreme high risk of psychosis.
authors.affiliation: Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; paolo.fusar-poli@kcl.ac.uk.|OASIS Service, South London and the Maudsley NHS Foundation Trust, London, UK.
authors.forename: Paolo
authors.initials: P
authors.lastname: Fusar-Poli
authors.affiliation: Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.|Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Cappucciati
authors.affiliation: Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.|Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: De Micheli
authors.affiliation: Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.|Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
authors.forename: Grazia
authors.initials: G
authors.lastname: Rutigliano
authors.affiliation: Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.|OASIS Service, South London and the Maudsley NHS Foundation Trust, London, UK.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Bonoldi
authors.affiliation: Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.|OASIS Service, South London and the Maudsley NHS Foundation Trust, London, UK.
authors.forename: Stefania
authors.initials: S
authors.lastname: Tognin
authors.affiliation: Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.|Department of Neurofarba, University of Florence, Florence, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Ramella-Cravaro
authors.affiliation: Postgraduate School of Child Neuropsychiatry, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: Augusto
authors.initials: A
authors.lastname: Castagnini
authors.affiliation: Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
authors.forename: Philip
authors.initials: P
authors.lastname: McGuire
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D038801:International Classification of Diseases; D008137:Longitudinal Studies; D008297:Male; D011618:Psychotic Disorders / Q000145:classification / Q000175:diagnosis* / Q000503:physiopathology; D018570:Risk Assessment; D012559:Schizophrenia / Q000145:classification / Q000175:diagnosis* / Q000503:physiopathology; D055815:Young Adult
keywords: BLIPS; CAARMS; UHR; brief psychosis; diagnosis; prevention; psychosis; risk; schizophrenia